The impact of assertive outreach teams on hospital admissions for psychosis: a time series analysis

Abstract

Although the assertive outreach model was developed in the United States and imported to the United Kingdom to date, there is only limited evidence to support its wide-scale implementation within the United Kingdom. This is the first study to have combined a large dataset with this type of research method to explore the impact of assertive outreach teams on hospital admissions. The introduction and expansion of assertive outreach teams was associated with reducing hospital admissions for people with psychosis. This study found a consistent summer peak in hospital admissions which community and in-patient mental health nurses should take account of and plan for. Ever since the Mental Health Policy Implementation Policy Guide paved the way for the introduction of the Assertive Outreach Treatment (AOT) model in England, the impact of this approach has been the subject of considerable debate but limited evaluation. To date, most of the evidence supporting this model has originated from outside the United Kingdom. A central aim of the AOT was to reduce the need for in-patient treatment. We aimed to assess the impact of the AOT model on hospital admissions for people with psychosis in England. Interrupted time series analysis was used in this study to evaluate the impact of the policy change. Following the introduction of the AOT model, a statistically significant reduction in hospital admissions for psychosis was found. In addition, we observed a repeated, annual summer peak in admissions. This study adds to the international evidence which supports the effectiveness of the AOT model in reducing hospital admissions for people with severe mental health problems. We offer five suggested implications for mental health nurses and clients based on our findings.

Predictors for clinical deterioration of mental state in patients assessed by telephone‐based mental health triage

“…Case‐managed patients with a high‐risk profile could be targeted for more assertive outreach that aims to detect signs of mental deterioration and facilitate prompt intervention (Hamilton et al . ).…”

The effect of psychiatric decision unit services on inpatient admissions and mental health presentations in emergency departments: an interrupted time series analysis from two cities and one rural area in England

“…Since mental healthcare service utilisation is known to follow a seasonal pattern (Hamilton et al. , 2015), Fourier terms based on (trigonometric) sine and cosine functions with a period of 1 year were also included (Lopez-Bernal et al. , 2016).…”

People with severe mental illness as the perpetrators and victims of violence: time for a new public health approach

“…9 It is clear that cuts in mental health service expenditure in England in the past decade have led to a reduced quality of overall care, 10 including a large scale national decommissioning of the assertive outreach teams that previously supported continuity of care for people with severe mental illness. 11 Public health approaches to violence reduction in the future therefore need to consider general factors associated with violence, such as access to weapons and socioeconomic deprivation, and issues specific to mental health, including continuity of care, appropriate treatment for people with severe mental illness, and effective interventions to reduce substance use disorders. 12,13 Future research is required to estimate whether the costs of such interventions might offset the health, criminal justice, and wider societal savings that would accrue from such a public health approach.…”