Herinckx‐Oregon 1996.

Methods	Allocation: randomised. Design: single centre. Duration: 29 months. Country: Portland, Oregon, USA.
Participants	Diagnosis: schizophrenia, major affective disorder, paranoid disorder, or another severe mental disorder; diagnostic criteria not reported. N = 178. Setting: community. Age: > 18 years, mean 36.5 ± 10.3 years (N = 163). Sex: 61% M (N = 163). Ethnicity: 18% black (understood to be African‐American). *History: i. chronically mentally ill, ii. history of persistent psychotic symptoms not due to substance abuse, iii. impaired functioning in > 2 of (i) social role, (ii) daily living, (iii) social acceptability, iv. no mental retardation. In process of being discharged from hospital or transferring to new service providers within community.
Interventions	1.ICM**: Assertive Community Treatment from combined teams staffed by consumers (N = 58) and not staffed by consumers (N = 59). ACT following the Stein and Test model. Caseload: 1:10. N = 117. 2. Standard care***: provided by 1 of 4 CMHCs and a number of smaller, more specialised agencies (none providing assertive outreach). Average caseload ˜ 1:27. N = 61.
Outcomes	Service use: not remaining in contact with psychiatric services****, admitted to hospital, number visits to emergency room. Social functioning: accomodation status, arrests. Unable to use ‐ Social functioning: employment status, illicit drug use (not reported). Mental state: general symptoms (not reported). Quality of life: measurement instrument not specified (data not reported). Satisfaction with services: measurement instrument not specified (not reported).
Notes	*60% psychotic disorders, 40% affective disorders, 33% severe alcohol or drug use comorbidity, 61% 2+ admissions in last 6 months. **Staff members were self identified mental health consumers DSM‐III‐R axis I diagnosis (˜ 50% of staff had a diagnosis of bipolar disorder). ***In the standard care group: caseload ˜ 1:15 is provided to ˜ 33% participants. ****Disengagement does not include who moved out, who refused to be re‐interviewed, death.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Randomised. Ratio randomisation between interventions: ICM:SC = 2:1. No further details.
Allocation concealment (selection bias)	Unclear risk	No details
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Primary outcome: clinician/participant mediated ‐ rating ‐ Unclear. Secondary outcomes: clinician/participant mediated ‐ rating ‐ Unclear.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Problematic to blind participants and those providing the intervention in studies comparing ICM intervention with standard care.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Source of data not reported.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Missing data are not addressed.
Selective reporting (reporting bias)	High risk	Not all listed outcomes of interest are reported.
Other bias	Low risk	No details. No evidence of the presence of other bias.