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Processes of disengagement and engagement in assertive outreach patients: qualitative study

  • Stefan Priebe (a1), Jay Watts (a1), Mike Chase (a1) and Aleksandra Matanov (a1)

Abstract

Background

Assertive outreach has been established to care for ‘difficult to engage’ patients, yet little is known about how patients experience their disengagement with mainstream services and later engagement with outreach teams.

Aims

To explore the views of disengagement and engagement held by patients of assertive outreach teams.

Method

In-depth interviews were conducted with 40 purposefully selected patients and analysed using components of both thematic analysis and grounded theory.

Results

Patients reported a desire to be independent, a poor therapeutic relationship and a loss of control due to medication effects as most important for disengagement. Time and commitment of staff, social support and engagement without a focus on medication, and a partnership model of the therapeutic relationship were most relevant for engagement.

Conclusions

The findings underline the importance of a comprehensive care model, committed staff with sufficient time, and a focus on relationship issues in dealing with ‘ifficultto engage'patients.

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Copyright

Corresponding author

Professor Stefan Priebe, Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK. E-mail: S.Priebe@qmul.ac.uk

Footnotes

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Declaration of interest

None.

Footnotes

References

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Billings, J., Johnson, S., Bebbington, P., et al (2003) Assertive outreach teams in London: staff experiences and perceptions. Pan-London Assertive Outreach Study, Part 2. British Journal of Psychiatry, 183, 139147.
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Processes of disengagement and engagement in assertive outreach patients: qualitative study

  • Stefan Priebe (a1), Jay Watts (a1), Mike Chase (a1) and Aleksandra Matanov (a1)
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eLetters

Not the full story with African-Caribbean patients

olufemi oluwatayo, consultant psychiatrist
30 November 2005

Dear Editor,I read with interest this paper by Priebe et al. I commend the authors fortheir work in trying to throw more light on our understanding of factors influencing patients' engagement with services, especially African-Caribbean patients.

Amongst other studies, our study (Oluwatayo & Gater, 2004) showedthat African-Caribbean patients are more likely to disengage from servicesthan their White British counterparts. Not much work has been done in understanding the reason for this. I feel the sort of qualitative approachused in this paper is the way forward.

I however wish to comment on the their conclusion that African-Caribbean patients do not have a qualitatively distinct process of disengagement with services. I feel we need to know more before we can come to such conclusion. I will focus on size of study and one aspect of the views explored.

In my opinion the views of 18 African-Caribbeans patients are not enough to make a definitive conclusions on such an important subject, moreso when the patients are those that have re-engaged with services after a period of disengagement. It will be more informative to interview more of them in terms of absolute numbers and those in different situations for example those who have not re-engaged in the community, in secure units, in prison etc.

With regard to the content of the views explored, of the three main themes that emerged from their study, the "desire to be independent and able person" touch on the area of insight that interests me. This theme includes the patients' acceptance of being mentally ill. I will be interested in knowing how many of the 26 patients who expressed difficultyin this theme are of African-Carribean origin, my feeling is that there will be disproportionately more African-Caribbeans.

My clinical experience with African-Caribbean patients indicates thatthe idea of being mentally ill is a very difficult one to accept and this impacts on every other aspects of their care including disengagement from services. Of equal importance is what it actually means to be mentally illand what the psychotic symptoms means to them, say for example in terms ofcoping with a society that they perceive as completely hostile to them.

I implor the authors and other researchers in the field to consider these points in future studies.

Thank you

References:Oluwatayo, O.G & Gater R (2004) The role of engagement with services in compulsory admission of African-Caribbean patients. Social Psychiatry and Psychiatry Epidemiology, 39 (9), 739-743.
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Conflict of interest: None Declared

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