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  • Assertive Outreach: Advances in Psychiatry March 2000

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    Assertive outreach aims to provide intensive community support for those with severe mental illness who have difficulty engaging with traditional services. It involves small caseloads, proactive engagement, a team approach, crisis intervention, and long-term commitment. Assertive outreach targets about 5% of adults with severe mental illness who are socially excluded and vulnerable. It has been shown to reduce hospitalization and improve housing stability, medication adherence, and quality of life.

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    Assertive outreach aims to provide intensive community support for those with severe mental illness who have difficulty engaging with traditional services. It involves small caseloads, proactive engagement, a team approach, crisis intervention, and long-term commitment. Assertive outreach targets about 5% of adults with severe mental illness who are socially excluded and vulnerable. It has been shown to reduce hospitalization and improve housing stability, medication adherence, and quality of life.

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    21 views3 pages

    Assertive Outreach: Advances in Psychiatry March 2000

    Uploaded by

    ruddie_2009
    Assertive outreach aims to provide intensive community support for those with severe mental illness who have difficulty engaging with traditional services. It involves small caseloads, proactive engagement, a team approach, crisis intervention, and long-term commitment. Assertive outreach targets about 5% of adults with severe mental illness who are socially excluded and vulnerable. It has been shown to reduce hospitalization and improve housing stability, medication adherence, and quality of life.

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    of 3

    ‘a problem solving orientation in

    which staff attend to specific life


    issues, no matter how mundane;

    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 Stein reiterates that treatment programmes need


    to expand their interest from just psychological
    The Foundation NHS Trust & The interventions to address everyday problems
    Sainsbury Centre for Mental Health such as material resources, teaching coping
    strategies to meet the demands of community
    life, supporting and educating community
    Effective care in the community for those with members involved with patients (police,
    severe and enduring difficulties has become housing officers, shopkeepers, etc.), and
    one of the main focuses for service provision, provide enough support to keep the individual
    with legislation such as the Mental Health motivated. A community mental health team
    (Patients in the Community) Act 1995, needs to identify and understand a range of
    Building Bridges (1995), The Spectrum of mental health needs and problems (Wood
    Care (1996) and the National Service 1997). These include mental and physical
    Framework for Mental Health (1999) health needs; levels of support networks and
    complementing the existing Mental Health Act social functioning; housing and
    1983. The elements of these documents include accommodation requirements; welfare benefit
    challenging roles for clinicians in terms of and financial status; carer support needs;
    responsibility and accountability. Through employment, training and occupational
    integration with a local Care Programme achievements and needs; and the influence of
    Approach, a comprehensive system of support culture, gender, sexuality and spiritual beliefs.
    and communication is expected to be applied in
    terms of co-operation, contact (through Assertive Outreach is a multidisciplinary
    structured aftercare planning), transition, and framework which specifically targets those with
    by developing strategies for assertive outreach. severe and persistent mental disorder, who are
    In the last fifteen years or so, there have been vulnerable to elements of risk and have found
    notable developments within the concept of some difficulty in engaging with more traditional
    assertive outreach services. The most inspiring services.
    model was the Training in Community Living
    programme developed by Stein (1980), which
    evolved and modified towards the localised
    practices seen today. There is, however, a
    common values base across such practices
    which include:

    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

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