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Staff attitudes towards particular client difficulties in assertive outreach teams

Published online by Cambridge University Press:  13 June 2014

Rowena Jones ,
Dermot McGovern  and
Bethan Reading
Rowena Jones*
Affiliation:
West Midlands Poisons Unit, City Hospital, Birmingham B18 7QH, UK
Dermot McGovern
Affiliation:
Ladywood Assertive Outreach Team, Ladywood Middleway, Ladywood, Birmingham B1 2JT, UK
Bethan Reading
Affiliation:
Early Intervention Service, Harry Watton House, Church Lane, Aston, Birmingham B6 5UG, UK
*
*Correspondence Email: [email protected]
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Abstract

Objective: Over recent years in England there has been widespread development of assertive outreach teams supporting patients with severe mental illness living in the community. Assertive outreach staff members are exposed to a variety of new stressors and risks. This study investigated the emotional impact on keyworkers of working with assertive outreach patients. This was considered in terms of the attitudes keyworkers hold towards patients with particular types of difficulty. The study also measured individual keyworker stress.

Methods: Keyworkers from three teams in Birmingham were surveyed regarding their attitudes towards individual patients. Questionnaires measuring attitudes and patient difficulties were derived for the purpose of the study. Strengths of attitudes were correlated against different patient difficulties. Keyworker stress was measured using the General Health Questionnaire, GHQ12.

Results: Certain patient difficulties, in particular poor engagement, psychotic symptoms and aggression were associated with feelings of failure in keyworkers whilst drug use, particularly crack cocaine use, was associated with fear of visiting patients at home. Some 41% of keyworkers met ‘caseness’ criteria on the GHQ12. Negative attitudes appeared to be independent of GHQ scores.

Conclusions: Keyworkers expressed a number of positive and negative attitudes in relation to patient difficulties. Negative attitudes did not appear to be simply a feature of keyworker stress, however it is acknowledged that the sample size was small. Keyworkers' responses suggested a sense of personal failure when their patients were unwell or poorly engaged, despite patients being selected for assertive outreach on the basis of such difficulties. Recognition of negative attitudes may help in the improvement of training and supervision of staff members.

Keywords

AttitudesStressAssertive outreachKeyworkers.
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 25 , Issue 4 , December 2008 , pp. 131 - 136
Copyright
Copyright © Cambridge University Press 2008

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References

1.National Service Framework for Mental Health. London: DoH, 1999.Google Scholar
2.Presser, D, Johnson, S, Kuipers, Eet al.Mental Health, ‘Burnout’ and Job Satisfaction among Hospital and Community-based Mental Health Staff. Br J Psychiatry 1996,169, 334–337.CrossRefGoogle Scholar
3.Onyett, S, Pillinger, T, Mullen, M. Job Satisfaction and burnout among members of community mental health teams. J Mental Health 1997; 6(1): 55–66.Google Scholar
4.Wykes, T, Stevens, W, Everitt, B. Stress in community care teams: will it affect the sustainability of community care? Soc Psychiatry Psychiatric Epidem 1997; 32: 398–407.CrossRefGoogle ScholarPubMed
5.The Mental Health Policy Implementation Guide. London: DoH, 2001.Google Scholar
6.Stein, L, Test, M. (1980). Alternative to Mental Hospital Treatment 1. Conceptual Model, Treatment Program and Clinical Evaluation. Arch Gen Psychiatry 1980; 37: 392–397.CrossRefGoogle Scholar
7.Marshall, M, Lockwood, A. Assertive Community Treatment for people with severe mental disorders. In: The Cochrane Library, 2001; Issue 3Google Scholar
8.Boyer, Bond. Does Assertive Community Treatment reduce burnout? A comparison with traditional case management. Mental Health Serv Res 1999; 1(1): 31–45.CrossRefGoogle Scholar
9.Billings, J, Johnson, S, Bebbington, Pet al.Assertive Outreach Teams in London: staff experiences and perceptions. Br J Psychiatry 2003; 183:139–147.CrossRefGoogle ScholarPubMed
10.Safety First. Five year report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. 2001.Google Scholar
11.Priebe, S, Fakhoury, W, Watts, Jet al.Assertive outreach teams in London: Patient characteristics and outcomes: Pan-London Assertive Outreach Study, Part 3. Br J of Psychiatry 2003; 183(2): 148–154.CrossRefGoogle ScholarPubMed
12.Graham, H, Maslin, J, Copello, Aet al.Drug and Alcohol problems amongst individuals with severe mental health problems in an inner city area of the UK. Soc Psychiatry Psychiatric Epidem 2001; 36: 448–455.CrossRefGoogle Scholar
13.Tackling Crack. A National Plan Home Office Publication, 2002.Google Scholar
14.Kavanagh, D. Recent Developments in expressed emotion and schizophrenia. Br J Psychiatry 1992; 160: 601–620.CrossRefGoogle ScholarPubMed
15.Tattan, T, Tamer, N. The expressed emotion of case managers of the seriously mentally ill: the influence of expressed emotion on clinical outcomes. Psychol Med 2000; 30: 195–204.CrossRefGoogle ScholarPubMed
16.Frank, A, Gunderson, J. The Role of the Therapeutic Alliance in the Treatment of Schizophrenia. Relationship to Course and Outcome. Arch Gen Psychiatry 1990; 47: 228–236.CrossRefGoogle ScholarPubMed
17.Neale, M, Rosenheck, R. Therapeutic Alliance and Outcome in a VA Intensive Case Management Program. Psychiatric Serv 1995; 46(7): 719–721.Google Scholar
18.National PCT Database Indices of Deprivation. ODPM, The English Indices of Deprivation. London: Office of the Deputy Prime Minister, 2004.Google Scholar
19.Murphy, R. Developing a scale to measure psychotic patients' engagement with mental health services. BSc Project. University of Aston, Birmingham, 1998.Google Scholar
20.Goldberg, D, Williams, P. A User's guide to the General Health Questionnaire. NFER Nelson Publications. Darville House, 2 Oxford Road East, Windsor, Berkshire SL4 1DF (1988, reprinted 1991)Google Scholar