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 – 20 of those Gypsies and Travellers - 9 Total = 64 service users/avoiders and 9 carers Plus 32 staff (in 5 focus groups) Sample 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