Dr Geraldine Strathdee, NHS England’s national clinical director for mental health recently told Community Care:
“I know there are a number [of Trusts] saying ‘we won’t have a crisis/home treatment team. Instead we’ll put that crisis team function, or that assertive outreach function, into generic services’. I’d urge anyone going with that approach to really evaluate the impact.
We know from really robust research that if we want to continue the major gains that we’ve made in this country with out of hospital care, with reduced suicide above all, that there is a technology attached to the way crisis home treatment teams and assertive outreach operate. I think where people are seeing those as just functions, rather than highly skilled teams, I would really urge them very strongly to evaluate the impact.”
What has Norfolk & Suffolk NHS Foundation Trust (NSFT) done? It has gone against all the evidence and the advice of the national clinical director and closed down its dedicated Assertive Outreach (AO) teams and created ‘generic services.’ NSFT is also losing experienced, skilled Assertive Outreach professionals, who know service users and how to keep them safe, as part of its £7.3 million redundancy fiasco. Continuity of care is critical for humane and effective care but doesn’t feature in the ‘radical redesign.’
Cared for by an Assertive Outreach teams, a person would have been perhaps one of ten on a professional’s caseload and would know, and be well-known to, the whole team; a team which also worked at weekends. Now these same vulnerable people are relying on professionals who have caseloads of 40 or sometimes more, in a service that does not operate at weekends. How many changes of worker have this group of people had in the last year? They are going without continuity, without consistency, without a solid relationship with people whom they know well and trust, without treatment and care based upon best practice.
Other specialist teams, such those working in Early Intervention (EI) or with the homeless, have also been disbanded, deskilled or cut.
“Trusts that merged their specialist community teams (e.g. assertive outreach, early intervention) with their generic community mental health services had higher suicide rates in 2012 than trusts that retained their specialist teams.”
NSFT’s website still claims it operates Assertive Outreach teams. In fact, NSFT has done the exact opposite and closed them down.
Whether you use mental health services, are a carer or member of the staff, let us know your stories: we’re stronger together.