WANDSWORTH%20ASSERTIVE%20OUTREACH%20

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WANDSWORTH ASSERTIVE OUTREACH RECOVERY TEAM

• Dr Gunam Kanagaratnam,
• Associate Specialist
• Dave Ramkhelawon
• Team Manager

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BACK GROUND

• Merger of two clinical management concepts
• Intensive care in the community
• Rehabilitation services in the community

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Recovery Model

• Enable and establish remission
• Sustain remission
• Enable recovery

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Wandsworth Assertive Outreach Recovery Team

• Assertive Community Team
• Community Rehabilitation Programme Residential
  facilities in the community, Peripatetic homes
  managed by the POSH Team partial
  hospitalization and support at home

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Patient Characteristics

• Adults with severe and ongoing mental illness
• Problems as a result of their mental illness and
  needs associated with it
• Current number of patients 143
• In the borough of Wandsworth

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Referrals this is a tertiary servicefrom the

• Community Mental Health Teams
• Acute in patient units
• Forensic Services
• Rehabilitation Services

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Referral Process

• Comprehensive referral from the team to include
  the following
• Detailed psychiatric history, forensic history,
  risk assessment, physical health -medication
  history
• History of associated substance and drug abuse

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Referral process (ii)

• Family history, social history
• Accommodation / housing
• Employment
• Income / statutory benefits

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Assessment

• Bio psycho social assessment

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Intervention

• Needs lead
• Bio psychosocial intervention

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Management by the team

• Multidisciplinary
• Psychiatrist
• Community Psychiatric Nurses
• Social workers
• Occupational therapists
• Support Workers

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Daily meetings

• Attended by all the members of the Team
• Hand over
• Zoning
• Discuss clinical and management problems
• All patients in the red zone are discussed
• Then the Clinical Case Managers proceed to visit
  their patients

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• Activities by the Clinical Case Managers
• Supervised medication
• Psycho social intervention
• Psycho education
• Resolving their existential needs
• Monitor mental state
• Arrange clinical reviews

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Some notable achievements

• CPA
• Physical health monitoring
• Clozapine treatment
• Direct payment
• Safeguarding vulnerable adults
• Carers groups

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Safeguarding vulnerable adults

• All persons have the right to live their lives
  free from violence and abuse.
• This right is underpinned by the duty on public
  agencies under the Human Rights Act (1998) to
  intervene proportionately to protect the rights
  of citizens.
• These rights include
• Article 2 the Right to life
• Article 3 Freedom from torture (including
  humiliating and degrading treatment) and
• Article 8 Right to family life (one that
  sustains the individual).

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Remission criteria in Schizophrenia

• The patient achieves PANSS level of mild or less
• - ( score of 1 to 3)
• On all 8 symptom items
• - P1 Delusions
• - P2 Conceptual disorganisation
• - P3 Hallucinatory behaviour
• - G9 Unusual thought content
• - G5 Mannerisms and posturing
• - N1 Blunted affect
• - N4 Social withdrawal
• - N6 Lack of spontaneity / flow of conversation
• Duration of at least 6 months

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Definition of recovery

• The process in which people are able to live,
  work, learn and participate fully in the
  community.
• For some individuals recovery is the ability to
  live a fulfilling and productive life despite a
  disability.
• For others recovery implies a reduction or
  complete remission of symptoms.
• Science has shown that having hope plays an
  integral role in an individuals recovery.

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Recovery Criteria

• Recovery criteria must be met in each of the 4
  domains.
• Improvement in each domain must be sustained
  concurrently for at least 2 years.
• Level of recovery in these 4 domains is measured
  by symptom remission, appropriate role function,
  ability to perform day to day living tasks
  without supervision and social interaction.

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Notable achievements -

• Throughput of about 15
• Robust discharge protocol
• Joint working with referrers

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Addenda

• CPA Form
• Transfer of care