Background Assertive outreach has been established to care for‘difficult to engage’ patients, yet little is known about how patients experience their disengagement with mainstream services and later engagement with outreach teams.

Aims To explore the views of disengagement and engagement held by patients of assertive outreach teams.

Method In-depth interviews were conducted with 40 purposefully selected patients and analysed using components of both thematic analysis and grounded theory.

Results Patients reported a desire to be independent, a poor therapeutic relationship and a loss of control due to medication effects as most important for disengagement. Time and commitment of staff, social support and engagement without a focus on medication, and a partnership model of the therapeutic relationship were most relevant for engagement.

Conclusions The findings underline the importance of a comprehensive care model, committed staff with sufficient time, and a focus on relationship issues in dealing with ‘difficult to engage’ patients.

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