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

Abstract

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.

Assertive outreach teams have been introduced in most parts of England to assist in the management of severe mental illness. To improve their effectiveness, we need to know what factors are associated with favourable outcome. The Pan-London Assertive Outreach Study (PLAO) investigated the routine practice of assertive outreach teams in London. It established how teams are organised and operate (Wright et al, 2003), assessed staff burn-out and satisfaction (Billings et al, 2003), identified socio-demographic and clinical characteristics of patients and recorded rates of hospitalisation and compulsory admissions within a 9-month follow-up period (Priebe et al, 2003). The present paper explores the baseline characteristics of teams, staff and patients that predict outcomes over the 9-month follow-up.