language which is understandable and common to the service user 2. Concentrate on strengths focused interventions 3. Be prepared to give as much time as the service user needs; know when to back off / give space but remain available to the person 4. Encouage as much independence as possible 5. Encourage and support “mainstream” social, recreational, educational and occupational pursuits 6. Be prepared to give assistance with practical tasks 7. Offer problem solving approaches to service users and their carers 8. Be consistent; use low key, unobtrusive persistence to attempt to engage someone 9. Be flexible 10. Be supportive Case illustration Adam is a 21 year old man with a four year history of florid psychosis, marked by unremitting persecutory delusional ideation and significant perceptual difficulties. Over the years, Adam’s problems had been compounded by poor concordance with medication, substance misuse issues and a chaotic domestic lifestyle in which he regularly physically assaulted family members with whom he was living. Prior to referral to the assertive outreach team in 2006, Adam had been unwilling to see anyone from the Community Mental Health Team (CMHT), and had been admitted numerous times to the local mental health inpatient unit under section 3 of the Mental Health Act. At the point of referral to the assertive outreach team, time was spent discussing the right approach to Adam’s problems. This reflective, multi-disciplinary focus allowed the team to collaboratively work out such issues as: who would be best to take on the role of care coordinator? Was a team based or individual approach best initially? How could meaningful care plans and risk assessments best be undertaken? In what way should family members be involved? What lessons could be learned from previous approaches? A significant issue relating to Adam’s unwillingness to engage with mainstream mental health services was his risk of aggression and violence to health care professionals. He had consistently threatened to “smack” those who came to his door, a situation which, perhaps understandably, led to a reluctance of the CMHT to attempt visiting.
32 Consequently, Adam’s father increasingly became his primary care provider, and although this was beginning to affect his own health, no-one had attempted to approach him with a view to addressing these difficulties. An action plan was drawn up which included the following principles: A member of the assertive outreach team was identified to make contact with Adam’s father and arrange a carers assessment. With his consent, it was decided to visit Adam’s father when Adam was actually at home, in order to involve him in any discussion that might ensue. The rationale for this was to open up a transparent dialogue with Adam, rather than compound his suspicions and anxieties by making decisions without him being present.