Assertive community treatment in UK practice

REVISITING... SETTING UP AN ASSERTIVE COMMUNITY TREATMENT TEAM

Andrew Kent is a reader in psychiatry at St George’s, University of London (Department of Psychiatry, Jenner Wing, Cranmer Terrace, London SW17 0RE, UK. Email: akent{at}sgul.ac.uk). He collaborated with Tom Burns on the St George’s arm of the UK700 study of intensive case management. Tom Burns is Professor of Social Psychiatry at the University of Oxford, having moved from a similar position at St Georges. At St George’s he had consultant responsibility for an assertive outreach team established in 1994 which was awarded Beacon status by the Department of Health.

Since 2000 assertive outreach has been a requirement of community mental health provision in the UK. This has led to rapid proliferation of assertive community treatment teams offering a pure form of clinical case management to people with severe mental illness. The teams provide intensive support in obtaining material essentials such as food and shelter and place a greater emphasis on social functioning and quality of life than on symptoms. People with psychotic illness with fluctuating mental state and social functioning and poor medication adherence are most likely to benefit. Teams are ideally placed to monitor clozapine treatment in the community. Teams require a broad skills mix, and team members need some competence across a wide range of areas. Teams should include a psychiatrist or have regular access to one. Ideal individual case-loads are 10–12 patients. Around-the-clock availability is no longer considered essential, particularly in view of the rise of crisis resolution/home treatment teams.