Little is known about what characteristics of teams, staff and patients are associated with a favourable outcome of severe mental illness managed by assertive outreach.

To identify predictors of voluntary and compulsory admissions in routine assertive outreach services in the UK.

Nine features of team organisation and policy, five variables assessing staff satisfaction and burn-out and eleven patient characteristics taken from the baseline data of the Pan-London Assertive Outreach Study were tested as predictors of voluntary and compulsory admissions within a 9-month follow-up period.

Weekend working, staff burn-out and lack of contact of the patient with other services were associated independently with a higher probability of both voluntary and compulsory admission. In addition, admissions in the past predicted further voluntary and compulsory admissions, and teams not working extended hours predicted compulsory admissions in the follow-up period.

Characteristics of team working practice, staff burn-out and patients' history are associated independently with outcome. Patient contact with other services is a positive prognostic factor.

Assertive outreach teams have been introduced in the UK, based on the assertive community treatment (ACT) model. It is unclear how models of community care translate from one culture to another or the degree of adaptation that may result.

To characterise London assertive outreach teams and determine whether there are distinct groups within them.

Semi-structured interviews with team managers plus one month's prospective process of care data collection were used to test for ‘model fidelity'to ACT and, by cluster analysis, to identify groupings.

Fidelity varied widely, with four teams (out of 24 studied) rated ‘high fidelity’ and three teams rated ‘low fidelity’ by US standards and 17 rated ‘ACT-like’. Three clusters were identified, with voluntary sector teams being the most distinct group.

There is wide variation in the practice of assertive outreach in London. The role of the voluntary sector requires increased attention. Heterogeneity in practice is a clinical challenge but a research opportunity in distinguishing effective from redundant components of the approach.

The job satisfaction, burn-out and work experiences of assertive outreach team staff are likely to be important to the model's sustainability.

To describe self-reported views and workexperiences of staff in London's 24 assertive outreach teams and to compare these with staff in community mental health teams (CMHTs) and between different types of assertive outreach team.

Confidential staff questionnaires in London's assertive outreach teams (n=l87, response rate= 89%) and nine randomly selected CMHTs (n=114, response rate=75%).

Staff in assertive outreach teams and CMHTs were moderately satisfied with their jobs, with similar sources of satisfaction and stress. Mean scores were low or average for all sub-scales of the Maslach Burnout Inventory for the assertive outreach team and the CMHT staff, with some differences suggesting less burn-out in the assertive outreach teams. Nine of the 24 assertive outreach teams had team means in the high range for emotional exhaustion and there were significant differences between types of assertive outreach team in some components of burn-out and satisfaction.

These findings are encouraging, but repeated investigation is needed when assertive outreach teams have been established for longer.