Pervasive alienation: on seeing the invisible, meeting the inaccessible and engaging ‘lost to contact’ clients with major mental illness

Abstract

Increasing integration of services for adults with severe mental health problems has highlighted the challenges to services posed by clients who are difficult to engage. There is a dearth of studies on direct work with individuals who are reclusive and difficult to contact, in contrast with the bulk of literature where the patient and network are present and available. This paper describes the work of a busy CMHT with such clients; barriers to collaborative work are explored and some of the team's strategies to overcome these barriers are delineated. Long, slow and persistent contact is observed to be a core feature of the work. The paper goes on to examine the fit between the realities of ongoing work with such clients and the available therapeutic and service discourses.

• Community Mental Health Teams
• care programme approach
• Assertive Outreach
• hard-to-engage