I’m assuming readers already know what Assertive Outreach teams used to do. I say that because there is no such thing as assertive outreach any more. Even though this flannel from the Theemis report pretends there is. A few words on that first.
‘NHS England’s recent review and guidance indicates that assertive outreach should be a discrete resource but recognises while some ICBs (*) may already commission ‘assertive outreach’ teams or similar, others may not currently commission a specific team or service focused on intensive and assertive approaches. This aligns with the information and evidence provided to the independent investigation that suggested the majority of dedicated assertive outreach teams as a standalone function, were disbanded over 10 years ago. Alternative models for supporting service users who do not choose to or are unable to engage with mental health services have developed but there is variation in the approach…blah blah more b/s.
*) Inter Care Board, the latest title change for very senior people who want their well-remunerated careers to continue long after they dump working in health.
Try this translation instead. Assertive outreach, even as a concept is incompatible with least restrictive. Genius management and policy makers have set these two values in opposition to each other. Only one can win. Hint, it isn’t the one which keeps you and your loved ones safe.
Note again the ‘nice’ weasel words (in bold) suggesting there is no such thing as a violent, threatening dangerous patient out there refusing treatment or monitoring – no indeed, heaven forbid – there are only those who ‘who do not choose to or are unable to engage with mental health services.’ Lies, smoke and mirrors. I’ve nursed hundreds of such patients. And in recent times, it isn’t possible to treat and manage them safely, even in hospital, because politicians, special interest groups and managers have given them the right to be managed in the least restrictive manner (as decided by a manager behind a desk, not a real nurse on the ground floor) and policed by the threat of a disciplinary.
For Britain to have a real, functioning assertive outreach service (Go on, let’s rename it ‘Aggressive Outreach’) first we’d have to jettison the requirement that the overworked ground floor nurse has first, to wrestle with proving or disproving to management’s satisfaction – the patient’s capacity. If the patient is dangerous and refusing their meds (and even before they start relapsing) then risk must trump everything else and they come back into hospital. Nothing else matters. That approach, robustly applied, would have prevented Calocane. He gave more than enough early warnings. Untreated psychiatric patients ‘in the community’ are a moral disgrace to our country, they’re often immensely expensive in terms of public resources and social cohesion, they are accepted by no-one and rejected and pushed away by everyone. They probably use more illegal drugs than any other demographic group you can name. (And since none of them are employed, guess who is generously paying for the drugs?) And of course, some of them are dangerous to the public. Some fatally so.
Of course, to fix this we’d need a lot more hospital beds. That means building more wards and hospitals. And an acceptance that (as well as the dangerous Calocanes) there are heaps of non-functioning patients out there dying a slow death from neglect who should live in mental hospital with professionals nearby to care for, manage, organise, medicate, feed and water and police them. I and nurses my age know this is possible because we trained in these bins.
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