1. LIVERPOOL ASSERTIVE OUTREACH TEAM VINNIE FARRELL TEAM MANAGER ROBERT HIGGO CONSULTANT PSYCHIATRIST

2. POPULATION Inner City Liverpool Drifting Population Unstable Accommodation BEM Mix Dual Diagnosis Offending/Risk Behaviours Sounds familiar !

3. ESTABLISHMENT Formed 2000135 Caseload 1 Manager 1 Deputy Manager 12.5 Care Co-Coordinators 1 Assistant Nurse Practitioner 5 STR Workers.4 Psychologist 1 Consultant Psychiatrist 1 SpR / 1ST3

4. CASE MANAGEMENT Engagement is……. Trust Relationships (Carers/Service Users) Face to face contact Consistency in contact Monitoring of treatment plans Assessing risks Negotiation/Collaborative approach

5. DOWNSIDE Information shared ineffectively Less flexibility/team response Protecting caseloads Over Dependence Prevents Recovery Reduces Throughput

6. PREVENT AGAINST THIS BY : Team Ownership Team Responsibility Communication is key : Share knowledge Team Meetings Case Reviews / Presentations Use CPA effectively

7. PLAN – What are we doing ? Challenge – What / Why – Test out – Encourage innovative approaches – Supervision Don’t do more of the same!

8. CARE OF IN-PATIENTS Some figures : Admissions/year – 53 – 44 – 36 – 30 – 29 >50% come in informal and stay informal Maximum number >20 For last 2 years <10 Vast majority admitted directly by AOT

9. WE MANAGE OUR OWN IN- PATIENTS : Continuity Engagement Risk Management Discharge Planning Active in-reach

10. SOME NEGATIVE CONSEQUENCES : Not the fashion (in-patient consultants) Some longer admissions Activity figures Consultant case load numbers

11. HOW : Nothing radical ! Care Co-Ordinator in-reach Escorted leave Home visits Team discussion (Tuesday) Ward MDT (Thursday)

12. WELL PERSON CLINIC Why : Worse physical health Die early Co morbidity Little preventative health care Poor help seeking Medication effects

13. WELL PERSON CLINIC What : Started with monitoring – Clozapine, Lithium etc. Now, offered full screen Trainee Psychiatrist Assistant Practitioner (champion)

14. WELL PERSON CLINIC Benefits : A very thorough check Generally preferred by SU Engagement

15. WELL PERSON CLINIC Downside : Social inclusion Skills/limits Time costs Using Trainee

16. WELL PERSON CLINIC Future : GP session ? Audit