title: The replacement of assertive outreach services by reinforcing local community teams: a four-year observational study.
abstract: BACKGROUND
  The introduction of specialist Assertive Outreach (AO) teams has produced only modest differential findings from English studies compared to standard care. Providers have gradually closed AO services over the last 8 years. We previously studied outcomes at 12 months following the dismantling of two AO teams in London. We now report on the longer term outcomes for these patients.
  
  
  OBJECTIVE
  To evaluate the longer term outcomes, activity and costs for patients receiving a less intensive service.
  
  
  METHODS
  Observational service level evaluation of 112 patients comparing baseline of AO care with each year of routine care subsequent to the team closure.
  
  
  RESULTS
  Patients transferred to standard teams reinforced with the Flexible Assertive Community Treatment (FACT) approach had significantly fewer admissions and bed days at each of the four subsequent years compared to baseline, offset by a significant rise in missed face-to-face appointments. There was no significant change in the use of crisis services. Predictably patients had significantly fewer contacts under standard care.
  
  
  CONCLUSIONS
  AO patients are remarkably resilient to substantial reductions in the intensity of care. Reinforcing multi-disciplinary community mental health teams (CMHTs) with FACT appears to provide an integrated service that is clinically effective and an affordable alternative to orthodox AO teams.
authors: a South West London & St. George's Mental Health NHS Trust , London , UK , and.
authors: Mike
authors: M
authors: Firn
authors: b Population Health Research Institute, St Georges University of London , London , UK.
authors: Sarah Jane
authors: SJ
authors: White
authors: a South West London & St. George's Mental Health NHS Trust , London , UK , and.
authors: Dieneke
authors: D
authors: Hubbeling
authors: a South West London & St. George's Mental Health NHS Trust , London , UK , and.
authors: Ben
authors: B
authors: Jones
mesh_terms: D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000592:standards*; D005260:Female; D006699:Home Care Services / Q000592:standards; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult
keywords: Assertive; community; flexible; outreach; schizophrenia