I thank Dr Abrahamson for pointing out that the comment about “backlog of chronic cases” could be misconstrued as suggesting that chronic illnesses deserve lower priority. My use of the term “chronic” was not meant to describe ill patients with ongoing and unmet need. Acute CMHTs do and should attempt to reduce disability, maximise function and improve quality of life of patients with chronica illness. However, faced with the relentless pressure of new referrals, team members may hold onto stable patients in remission as part of their caseload. This compromises the team's ability to take on new referrals and reduces effectiveness. It may also distract resources away from those with greater need. Dr Abrahamson's point that imaginative use of community services can improve outcome is well made. Having a community rehabilitation team is just such an imaginative use of resources.
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