Mental health
Mental health
Feature
Our role, our experience
Once central to community mental health, assertive outreach teams have been scaled back over the past 15 years, with many absorbed into wider services. Now, with new national guidance bringing assertive, intensive care back into focus, OTs Chloe Firmstone, Jon Quinn, Adrianne Ronnenbergh, Ching Lum and Amina Idrees reflect on their experiences of working in assertive outreach.
T he assertive outreach model was first developed in the US and was later introduced in the UK to support service users in the community who are deemed at high risk of disengaging.
However, over the past 15 years, we have seen a reduction in assertive outreach teams across the country as they have been decommissioned and integrated back into community mental health teams.
Assertive outreach teams work with service users presenting with psychosis, who are difficult to engage, live with severe and enduring mental health problems, have high levels of social chaos, high usage of inpatient beds, and present with multiple, complex needs( Gregory and Macpherson 2010).
In July 2024, NHS England introduced guidance to integrated care boards on intensive and assertive community mental health care( NHS England 2024) to ensure care and treatment is provided in NHS trusts that meets the needs of these service users.
With the new guidance in mind, we wanted to share our experience of working in assertive outreach as occupational therapists in Birmingham and Solihull Mental Health NHS Foundation Trust.
How assertive outreach works in our trust
Within Birmingham and Solihull Mental Health NHS Foundation Trust there are six assertive outreach teams across the city. Each team is made up of nurses, doctors, support time recovery workers, a social worker, psychologist and an occupational therapist.
We have also recently introduced the role of Occupational Therapy Technical Instructor( OTTI), as well as a clinical and professional lead who provides leadership and strategic direction across the service.
Alongside our roles as occupational therapists, we work as care co-ordinators and form part of the team approach. Our dual role allows us to deliver focused interventions while contributing to the broader team-based approach that defines assertive outreach teams.
Our caseloads are smaller than our nursing colleagues so that we can follow our professional pathway, as well as support in generic duties that support the day-to-day running of the team.
We use the Occupational Circumstances Assessment Interview and Rating Scale( OCAIRS) to screen service users who present with occupational barriers and the Model of Human Occupation Screening Tool( MOHOST) for a more detailed assessment if needed.
Once strengths, barriers and goals have been identified with the service user, this is fed back in the weekly multidisciplinary team meeting, and the team decides who is best to carry out interventions and how this will fit into their visiting schedule.
Occupational therapists will regularly review and reassess as needed, but due to daily handovers and weekly multidisciplinary team meetings, the whole team can follow service user progress.
What do we do in an assertive outreach team?
Assertive outreach teams focus on quality of life and engagement in meaningful roles and social activities. The approach is individualised, meaning treatment looks different for everyone.
Some of the work we have undertaken as occupational therapists and care co-ordinators in our team includes:
22 OTnews September 2025