Assertive Outreach: Does it reach expectations?

Abstract

The study evaluated two voluntary sector Assertive Outreach (AO) teams. Team structures and functions were measured against an evidence-based model of assertive community treatment (ACT). Targeting and engagement were also considered. Outcome measures comprised mental health, quality of life, social functioning and user satisfaction. Users' contact with mental health services, and costs incurred, were measured. While the teams partly adhered to the ACT model, there were major areas of deviation. The teams had little influence over admission and discharge and no medical input. Local users with frequent hospital admissions were not targeted. Clinical and social outcomes were mixed, and hospital bed use - and, consequently, costs - increased. Conversely, clients valued the teams, especially the practical help provided and staff attitudes. The findings add to growing evidence that lack of adherence to the ACT model and inadequate targeting of the appropriate client group adversely affect outcomes. The question is whether the benefits of user satisfaction and engagement outweigh the costs of disappointing clinical outcomes and increased hospital use.