The replacement of assertive outreach services by reinforcing local community teams: a four-year observational study

Abstract

AO patients are remarkably resilient to substantial reductions in the intensity of care. Reinforcing multi-disciplinary community mental health teams (CMHTs) with FACT appears to provide an integrated service that is clinically effective and an affordable alternative to orthodox AO teams.

Flexible assertive community treatment (FACT) model in specialist psychosis teams: An evaluation

“…These differences were statistically significant and are of similar magnitude to the changes observed in the other UK study of FACT. 6 , 7 The number of contacts by support workers was not significantly different (0.25 compared with 0.29), but the proportion increased from 22 to 43%. In other words, the reduction of face-to-face contacts in the new FACT system for people previously in the ACT team was a result of less involvement of qualified staff.…”

“…An observational study in the UK has not shown negative effects in people previously supported by ACT teams in terms of hospital admissions or need for crisis resolution home treatment team (CRHT) interventions. 6 , 7 However, there have been no UK studies assessing whether there could be advantages for people previously supported by a CMHT but now receiving FACT. It might be expected that some people who have not previously had access to periods of more intensive support within the CMHT could benefit from the FACT approach, perhaps with a reduced need to have interventions from a CRHT or hospital admission.…”

Qualitative experiences of disengagement in assertive outreach teams, in particular for “black” men: Clinicians’ perspectives

“…Poor engagement is based on a number of influences, severity of illness, lack of insight into their presentation, views on treatment and diagnosis, substance misuse, lifestyle choices and perspectives on culture and stigma (Chakraborty, McKenzie, Hajat, & Stansfeld, ; Kreyenbuhl, Nossel, & Dixon, ). Engagement in treatment and developing effective working relationships between patients and clinicians were perceived as key vehicles within the AOT philosophy to improve treatment outcomes (Sainsbury Centre for Mental Health, ), and a reduction in hospital admissions continues to be evidenced in studies (Firn, White, Hubbeling, & Jones, ; Hamilton, Lloyd, Bland, & Savage Grainge, ) using an assertive community model of treatment. Warne () notes that AOT services remain crucial but that their importance can be overshadowed by services for those who are able to make themselves heard.…”

High mortality rate in people with severe mental disorders after discharge from assertive community treatment

“…However, the past few years have seen the closure of the majority of AO services in the United Kingdom, which was driven by the current economic climate and the negative findings of the only U.K. randomized controlled trial, which showed that care from AO teams did not reduce hospital admissions or improve clinical or social outcomes. While a number of observational studies have shown that alternative, less specialist, services were generally as effective as AO teams in reducing hospitalization none have specifically examined mortality in this patient group.…”

“…While a number of observational studies have shown that alternative, less specialist, services were generally as effective as AO teams in reducing hospitalization[5][6][7] none have specifically examined mortality in this patient group.AO service in the English county of Northamptonshire (mixed urban and rural population of nearly 700,000 people, mainly White British; 85.7%) was disbanded in 2014. Three years later we followed up the cohort of 190 patients who were under the care of the AO service at the time of its closure.…”