Ethics of assertive outreach (assertive community treatment teams).
OBJECTIVE
Assertive outreach, also known as assertive community treatment, is a well established service model in several countries for people with severe and enduring mental health problems who do no engage with psychiatric services. However, it has been criticized for being coercive and paternalistic. The present review considers a number of recent contributions to the debate concerning the ethics of assertive outreach.


RESULTS
Assertive outreach brings into sharp focus a number of ethical issues that affect most mental health services, but it also generates new ones, primarily whether delivery of a service to people who are refusing it and are not legally bound to accept it can be justified. Several authors have grappled with these issues, mainly through using traditional principles of ethical treatment based on professional values, and this paper reviews such attempts at resolving those dilemmas. In so doing, it reveals the limitations of such approaches.


CONCLUSIONS
In conclusion, the present review suggests an alternative ethical basis for supporting delivery of assertive outreach services to a reluctant client group, which focuses more on the client's values and areas of assistance with which they express genuine appreciation and satisfaction.
Williamson
Toby
T
Strategies for Living (Adult Mental Health & User Empowerment), The Mental Health Foundation, 83 Victoria Street, London SW1H 0HW, UK. twilliamson@mhf.org.uk
D026686:Beneficence; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders; D003156:Community Mental Health Services / Q000941:ethics*; D026689:Ethical Analysis; D006801:Humans; D026706:Paternalism; D026684:Personal Autonomy; D016312:Treatment Refusal / Q000941:ethics