A comparative study of assertive outreach and community mental health team support for people with mental health problems in Northern Ireland

Introduction: Assertive Outreach (AO) is a'specialist approach to working with people with severe and enduring mental health problems who are difficult to engage. It was established in Northern Ireland for the first time during 2003 so it was possible to take the opportunity to investigate its effectiveness in this context and to also examine some of the issues raised in other countries about this approach, including the level of perceived coercion and'quality of working relationships. Objective: To establish whether AD is an effective model of care for people with severe and enduring mental health problems in Northern Ireland, in comparison with standard Community Mental Health Team (CMHT) follow up. Design: This was a quasi-experimental design as it was not possible to rando':11ly allocate. There was an AD group (n=38) and a CMHT group (n=38). Key-workers and clients were interviewed at baseline and followed up at nine and eighteen months. Hospital use data was collected for all 76 who met the inclusion criteria. At baseline 60/76 consented to some form of involvement and it was possible to complete interviews for 55/60 over the 18 months. Main Measures: Clients were interviewed using standardised measures to assess satisfaction with services; the relationship with their key-worker; symptoms; empowerment; quality of life; coercion; childhood trauma; and insight. Key-workers were interviewed to assess. engagement; the relationship with their client; the strategies they use to encourage compliance; social functioning; and an overview of needs. Key findings: AO achieved a statistically significant reduction in hospital use (51 %). AO may improve engagement but this finding was not statistically significant. Less than half of the participants (24/55) had the same key-worker throughout the 18 months. AO workers used less potentially coercive strategies to encourage compliance.EThOS - Electronic Theses Online ServiceGBUnited Kingdo