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RESEARCH: Tom Burns, Jocelyn Catty, Michael Dash, Chris Roberts, Austin Lockwood, and Max Marshall Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression BMJ 2007; 335: 336 [Abstract] [Full text]

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Assertive Community Treatment: The South East CMHT, Barnet, Experience

Azad A Cadinouche, Latha Weston   (8 October 2007)

Assertive Community Treatment: The South East CMHT, Barnet, Experience 8 October 2007
Azad A Cadinouche, Staff Grade Psychiatrist CMHT South East 6th Floor Premier House Edgware HA8 7BJ, Latha Weston Send response to journal: Re: Assertive Community Treatment: The South East CMHT, Barnet, Experience	The Assertive Outreach Team for the London Borough of Barnet was disbanded in October 2006. The proviso was the respective CMHTs would integrate assertive community treatment and offer it as part of their package of service provision. In our current practice we have an identified list of patients, both ex-AOT and new. These patients fulfil most of the Burns & Firn criteria 4(severe enduring mental illness, poor adherence to medication, poor engagement with services, relapse would have severe consequences, fluctuating social functioning) and also they may have had frequent or lengthy acute hospital care 5. This list is scrutinised once weekly at the Multi Disciplinary Team meeting and patients are added or removed accordingly. There is a follow up twice weekly to monitor their progress or absence of. Our approach is based on the ‘Recovery/Strengths’ model 2. These patients are more likely to have complex needs with a higher use of domiciliary visits. They are offered a range of tailored interventions (ex. Daily living skills, problem solving skills, cognitive behavioural skills, addressing substance misuse, physical health monitoring, voluntary work, family interventions) 5 to promote social inclusion and rehabilitation. Our CMHT works collaboratively with the Crisis Resolution Home Treatment Team. This allows the extra community support and intensive monitoring, especially out of hours, in the home environment to limit social disruptions for those patients on the brink of hospitalisation. Due to resources limitations we cannot offer a ‘fidelity model’ of an Assertive Community Treatment Team 1.In our experience, offering community contacts and individualised care by a trained and motivated staff is an effective way of delivering assertive community treatment 3. Dr Azad Cadinouche, MD, MRCPsych Staff Grade Psychiatrist Dr Latha Weston, MRCPsych Consultant Psychiatrist CMHT South East, Premier House, Station Road, Edgware HA8 7BJ 1.Burns T, Catty J, Dash M, Roberts C, Lockwood A, Marshall M. Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression. BMJ 2007; 335:336-40 2.Killaspy H. Assertive community treatment in psychiatry. BMJ 2007; 335:311-2 3.Killaspy H, Bebbington P, Blizard R, Johnson S, Nolan F, Pilling S, king M. The REACT study: randomised evaluation of assertive community treatment in north London. BMJ 2006; 332: 815-20. 4.Kent A, Burns T. Assertive community treatment in UK practice. Advances in psychiatric treatment 2005; 11:388-97 5.Sainsbury Centre for Mental Health. Assertive Outreach Interventions. www.scmh.org.uk. Competing interests: None declared