Abstract
Assertive community treatment (ACT) was developed in the early 1970s as a means of coordinating the care of people with severe mental illness in the community. A Cochrane review of the effectiveness of ACT for the general adult population found that people receiving ACT were more likely to engage with services, and were less likely to be admitted to hospital (Marshall & Lockwood, 2000). The National Service Framework for Mental Health (Department of Health, 1999) and the NHS Plan (Department of Health, 2000) called for a total of 220 assertive outreach teams by April 2003.
Highlights
Hassiotis et al (2001) found that intensive case management was more beneficial for patients with borderline IQ than those of normal IQ, in terms of reduction in days spent in hospital, hospital admissions, total costs and needs, and increased satisfaction
A Dutch study showed a reduction in treatment costs of people with learning disability for outreach treatment in a randomised controlled trial of hospital v. outreach treatment (Van Minnen et al, 1997)
The Oxfordshire learning disability assertive outreach team shared the components of the programme of assertive community treatment (PACT) evaluated by Stein & Test (1980)
Summary
In Oxfordshire, the learning disability assertive outreach team has been running since October 2001 (Porter & Sangha, 2002). The audit involved contacting all community team members and managers of in-patient services to identify patients who might benefit from an assertive outreach team. The potential users were identified by applying the eligibility criteria described in Box 1 to all patients identified by the audit These criteria were developed from a series of meetings of the trust’s assertive outreach steering committee. They were in part drawn from the criteria used by the Sainsbury Centre for Mental Health (2001), but modified to include challenging behaviour (as these patients comprised a significant group) and exclude people who already had full-time supported living arrangements (because of resource implications). When a patient requires in-patient care the assertive outreach team continues to support the patient and aims to reduce the length of stay by participating in discharge planning
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