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Assertive Outreach: Advances in Psychiatry March 2000
Assertive Outreach: Advances in Psychiatry March 2000
Assertive Outreach
provision of most services directly,
rather than by referring clients to
another programme; a team
approach, in which the outreach staff
meets daily and shares responsibility
Advances in Psychiatry for the outreach to every client on the
caseload; and a long term
commitment to clients, providing
March 2000 services for as long as they persist.’
(Bond 1991).
Tom Dodd The Foundation NHS Trust, Corporation Street , Stafford. ST16 3AG Tel 01785 257888 Ext. 5838/9
Sainsbury Centre for Mental Health, 134-138 Borough High Street, London SE1 1LB Tel. 020 7403 8790
People with severe mental illness are
socially excluded, finding it difficult to
sustain social and family networks,
Who is Assertive Outreach for? access education, housing, gainful
Not for everyone or for every where, nor a recipe employment and healthcare.
to replace mainstream CMHT’s or standard
continuing care case management. NSF - Service Principles
Assertive Outreach must be structured as a Assessment from a number of perspectives
complementary service to cater to those Risk management
individuals with severe & disabling mental Multidisciplinary focus
illness who do not engage with regular services. Quality of the relationship
It is estimated that around 45 per 100,000 (about
Carer/Family involvement
5% of the adult population with SMI or 15,000
Access to Education, Employment and
nationally) would be included in the target
Housing
group. This would include individuals on the top
tier of the CPA, S117 aftercare and supervision Cultural competencies
registers. The model is particularly effective Broader Systems of Care
when dealing with problems of homelessness & NSF demands:
substance abuse. clear functions for CMHT’s
Emerging issues concerning rurality in the UK
range of interventions
context and the adaptability of this approach are
currently under debate; different approaches to timely response to crisis
developing an assertive outreach function must narrowing the primary / secondary divide
relate to local needs. access to inpatient facilities, or alternative
places for treatment
services which meet local needs
Effective Frameworks in Assertive
Outreach Broader Systems of Care
Small case loads 1:10 Who is targeted?
Proactive & assertive engagement What are the skills required?
Focus on a clearly defined population Who delivers?
Team approach What is the local need?
Team is main provider of services Who can we work with?
Crisis intervention Are there already services in place?
24 hour, 7 day week access Barriers to Implementation
Individualised & comprehensive treatment Lack of fidelity to the key ingredients
rehabilitation & support - adherence to the practices not just the
In-vivo treatment & rehabilitation principles
On-going, not time limited services AO team not main provider of services
Use of evidenced based interventions such Teams receive inadequate training,
as behavioural family work supervision & resourcing
Work with dual diagnosis, substance abuse Teams not targeted
& mental illness The placing of AO within the spectrum of
NSF - Current situation care
The metal health element of the global Outcomes From PACT Style Assertive
burden of disease is expected to rise Outreach
from 11% to 15% over the next 20
Time in hospital reduced
years.
5 out of the top 10 leading causes of Improved housing stability
disability are psychiatric conditions: Modest decrease in symptom severity
schizophrenia, bipolar depression, Improved medication adherence
unipolar depression, alcohol misuse and Modest improvement in functioning
obsessive compulsive disorder. Moderate improvement in quality of life
High levels of user and carer satisfaction