WANDSWORTH ASSERTIVE OUTREACH & RECOVERY TEAM Dr Gunam Kanagaratnam, Associate Specialist & Dave Ramkhelawon Team Manager

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

Recovery Model Enable and establish remission Sustain remission Enable recovery

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

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

Referrals – this is a tertiary service from the Community Mental Health Teams Acute in patient units Forensic Services Rehabilitation Services

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

Referral process (ii) Family history, social history Accommodation / housing Employment Income / statutory benefits

Assessment Bio – psycho – social assessment

Intervention Needs lead Bio – psychosocial intervention

Management by the team Multidisciplinary Psychiatrist Community Psychiatric Nurses Social workers Occupational therapists Support Workers

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

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

Some notable achievements CPA Physical health monitoring Clozapine treatment “Direct payment” Safeguarding vulnerable adults Carers groups

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).

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

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.

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.

Notable achievements - Throughput of about 15% Robust discharge protocol Joint working with referrers

Addenda CPA Form Transfer of care