WANDSWORTH ASSERTIVE OUTREACH & RECOVERY TEAM

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

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

3. Recovery Model • Enable and establish remission • Sustain remission • Enable recovery

4. 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

5. 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

6. Referrals – this is a tertiary servicefrom the • Community Mental Health Teams • Acute in patient units • Forensic Services • Rehabilitation Services

7. 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

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

9. Assessment • Bio – psycho – social assessment

10. Intervention • Needs lead • Bio – psychosocial intervention

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

12. 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

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

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

15. 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).

16. 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

17. 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.

18. 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.

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

20. Addenda • CPA Form • Transfer of care