Effective involvement in mental health services: the role of assertive

outreach and the voluntary sector

Bristol Mind

Aim of the study

To explore in depth how voluntary and statutory services can best work to promote effective access to services for people with severe mental illness who are perceived as being ‘hard to engage’ by those services.

• Black and minority ethnic groups– Gypsies and Travellers

Methodology

• Qualitative interviews– Topic guide to provide some structure– Recorded and transcribed– Thematic analysis (coded using MAXqda)

• Staff focus groups– Recorded, transcribed and analysed for themes

(coded using MAXqda)

• Mapping exercise – Questionnaires with both quantitative and qualitative

questions

People who • Had used assertive outreach services (AO) - 20• Had used voluntary outreach services (VO) - 12• Had gone out of contact with specialist mental

health services (OOC) - 15• Carers - 9

Black and minority ethnic groups – 20of those Gypsies and Travellers - 9

Total = 64 service users/avoiders and 9 carersPlus 32 staff (in 5 focus groups)

Sample GroupsSample Groups

Service user focus and involvement

• Shaping the proposal• Design of the research• Preliminary interviews shaped topic guide• Researchers had used services and

shared this information with participants• Members of the Advisory Group and

Steering Group• Dissemination of findings• Aim to improve services

Most people wanted help

• Most people in all sample groups wanted help for their problems

• Nonetheless they had problems accessing services

• People avoided services that did not respond to their priorities or offer what they wanted

Relationships

Consistent relationships with a few staff

Varied views relating to professionalism/informality

Participants wanted staff who were• Persistent and sought them out

• Friendly, approachable and who listened and cared

• Trustworthy

• Offered respect and did not judge

• ‘Like me’

• Willing to ‘go the extra mile’

Broad range of support

• Wide range of support wanted

– Accommodation and money most important

– Practical help with everyday living, activities

and social support

Informal emotional support

• ‘Being there’ and listening to problems– Need for informal ‘therapeutic’ support

• Talking therapies– Some people wanted more access– Some did not want them or found them

unhelpful

• People valued advocacy style support

Medication

• Significant issue – varied views– All that is on offer– Should not be the only focus of help– Staff push medication– Concern about high levels and side effects– For some medication was seen as important

and/or needed

• Often a reason for disengaging

What undermined engagement

• Having drug and alcohol problems

• Mental health services intrusive and controlling

• Being sectioned, forcibly medicated and inpatient stays

• No significant differences in range of views

expressed

• Most people felt staff were respectful

BME Groups excluding Gypsies and Travellers

Gypsies and Travellers

• Not accessing statutory or voluntary

outreach services

• Different approach needed to involve

people in the study

– Recruitment

– Language

• Findings have been written up separately

Over-arching themes

• People want help focused on their own priorities

• Need for more flexible and responsive approach to relationships between users and staff

• Need for both consistent relationships and a broad range of support including specialist support – significant challenge for service provision

Recommendations• Avoid labelling people as ‘hard to engage’ • Focus on user priorities• Recognise the importance of relationships• Offer a range of support• Improve access to mental health care and integrated

care for dual diagnosis• Maintain and develop a commitment to assertive

outreach and complementary voluntary outreach provision

• Address perverse incentives and reward organisations for working together in the longer term

• Consider using outreach services for other marginalised and excluded groups, for example, Gypsies and Travellers

Thank you

Rosie Davies

Assertive Outreach Research Project

Bristol Mind, 35 Old Market Street

Bristol BS2 0EZ

assertiveoutreach@bristolmind.org.uk

www.bristolmind.org.uk