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Characteristics of teams, staff and patients: associations with outcomes of patients in assertive outreach

Unit for Social and Community Psychiatry, Barts’ and The London School of Medicine

Ian White, PhD, MRC

Biostatistics Unit, Cambridge

Joanna Watts, MA

Unit for Social and Community Psychiatry, Barts’ and The London School of Medicine

Paul Bebbington, FRCPsych and Joanna Billings, MA

Department of Psychiatry and Behavioural Sciences, University College London and Camden and Islington Mental Health and Social Care Trust

Tom Burns, FRCPsych

Department of General Psychiatry, St George’s Hospital Medical School, London

Sonia Johnson, MRCPsych

Department of Psychiatry and Behavioural Sciences, University College London and Camden and Islington Mental Health and Social Care Trust

Matt Muijen, PhD and Iain Ryrie, MA

Sainsbury Centre for Mental Health

Christine Wright, FRCPsych

Department of General Psychiatry, St George’s Hospital Medical School, London

the Pan-London Assertive Outreach Study Group

Correspondence: Professor Stefan Priebe, Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK. Tel: +44 (0)20 7540 4210; fax: +44 (0)20 7540 2976; e-mail: s.priebe{at}qmul.ac.uk

Declaration of interest Funding provided by the Department of Health.

Background Little is known about what characteristics of teams, staff and patients are associated with a favourable outcome of severe mental illness managed by assertive outreach.

Aims To identify predictors of voluntary and compulsory admissions in routine assertive outreach services in the UK.

Method Nine features of team organisation and policy, five variables assessing staff satisfaction and burn-out and eleven patient characteristics taken from the baseline data of the Pan-London Assertive Outreach Study were tested as predictors of voluntary and compulsory admissions within a 9-month follow-up period.

Results Weekend working, staff burn-out and lack of contact of the patient with out and lack of contact of the patient with other services were associated independently with a higher probability of both voluntary and compulsory admission. In addition, admissions in the past predicted further voluntary and compulsory admissions, and teams not working extended hours predicted compulsory admissions in the follow-up period.

Conclusions Characteristics of team working practice, staff burn-out and patients’ history are associated independently with outcome. Patient contact with other services is a positive prognostic factor.

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