Rosenheck‐USA 1993.

Methods	Allocation: randomised. Design: multicentre. 10 sites: 6 General Medical and Surgical centres (GMS) and 4 Neuropsychiatric (NP) centres. Data available both for single centre and for 2 pooled centre groups (GMS and NP). See below. Duration: 24 months. Country: Northeastern United States
Participants	Diagnosis*: primary psychiatric disorder. N = 873. Setting: community‐based psychiatric care ‐ Department of Veterans Affairs (VA). Age: 48% > 45 years, mean 47.6 years. Sex: 100% M. Ethnicity: 20% non‐white. History: i. current inpatient in VA psychiatric unit, ii. no primary diagnosis of substance abuse or organic brain disease, iii. recent high user of psychiatric care (definition varied between GMS and NP centres), iv. written consent.
Interventions	1. ICM: Intensive Psychiatric Community Care programme, providing ACT intervention according to Stein and Test model. Caseload: average 1:7‐15. N = 454. 2. Standard care**: routine care from psychiatric services provided by Veterans Affairs, including inpatient and outpatient psychiatric treatment, psychopharmacological treatment, and rehabilitation service. N = 419.
Outcomes	Service use: average number of days in hospital per month (both pooled data for GMS and NP centres and data for single centre available; see below)***. Global state: GAS (authors reported results pooled for GMS and NP centres; see below). Mental state: BPRS‐18 item, BSI (authors reported results pooled for GMS and NP centres; see below). Costs: total healthcare cost (authors reported results pooled for GMS and NP centres; see below). Unable to use ‐ Global state: self reported measure (not published, not peer reviewed). Participant satisfaction: satisfaction with service (measurement instrument not published, not peer reviewed). Social functioning: Addiction Severity Index (ASI) (reported only a subscale, not the overall score). Costs: non‐healthcare costs (not listed as an outcome of interest in the review).
Notes	*Schizophrenia 50.5%, dual diagnosis 28%, bipolar disorder 10%. **Standard care provided by both types of centre did not differ programme wise. ***Pooled data for GMS and NP entered the meta‐analysis; data for single centre entered in meta‐regression.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomised through coin tossing.
Allocation concealment (selection bias)	Unclear risk	No details (reported only that the assignment by coin tossing was performed by an independent researcher).
Blinding (performance bias and detection bias) All outcomes	Unclear risk	Primary outcome: clinician/participant mediated ‐ rating ‐ Unclear. Secondary outcomes: interviewer rated ‐ rating ‐ Unclear. Authors report that interviewers are independent, but it is not stated whether they are blind to participant assignment.
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	Service use (hospital and nursing home service use) was derived from the VA's national computerised workload monitoring systems. Blinding not reported. Costs were determined using VA's standardised Cost Distribution Report.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	The study did not address this outcome.
Selective reporting (reporting bias)	High risk	Some listed outcomes of interest are not reported completely (i.e. substance abuse, which is reported only as a subscale score and not general score).
Other bias	Low risk	No details. No evidence of the presence of other bias.