512 / Assertive community care for people with severe mental disorders

Type of Patient Safety Practice SAFE
Clinical Practice (CP)
Related practices from PaSQ database
“Best fit” category of the reported practice


Patient identification
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
Coordination with social services working in the street for the identification of people with severe Mental Disorder homeless,and the implementation of a programme of progressive intervention conducive to establish adequate treatment and improve the quality of life of these people.
All of this with the combination of a specific team of direct intervention and with the support of identified in the whole of the network of Mental health professionals
This team works also directly with patients at high risk of social exclusion for the abandonment of treatment and lack or their family or social network vulnerability
The objective is to ensure a sufficient contact time as to the care project can be assumed by the affected person, and get its approach towards the natural care teams, both social and health
With the development of the intervention are obtained direct benefits in the affected person, to provide health care (mental health and overall health) and social, in order to be included in programs of social support.
On the other hand, gets an undoubted benefit in the greater acceptance of these people by social institutions, to work in coordination with mental health and receive support for their interventions.
And finally, reduces the stigma toward these people, bringing their problems to citizenship, reducing, at the same time, the risk of social risk behaviours.
Description of the Patient Safety Practice
1.-Meet criteria of TMG.
• TMG people vulnerable and that they do not attend services
• TMG people in situation of social exclusion and the homeless.
• TMG with vulnerable families and people with especially complex relationships
• TMG without resources or people with very limited resources, without family support and social networks that are in a program whose continuity requires sustained support.2.-In a situation of serious social repercussions, either by
• High dependency.
• Overload family.
• Absence of social network.
• Improper use of services..3.-This implementation phase, covers users of the urban area of Seville.

The Alliance for Patient Safety recommends addressing the problem of patient safety at the national level through the development of a culture of patient safety with a systemic and systematic approach, the establishment of information systems that support learning and decision-making, and the involvement of patients and citizens in the process.

For mental health, and for users to whom this practice refers, characterized by the situation described in paragraph TARGET POPULATION, most of the expected Adverse Effects are related with these people disengagement from the health network on the one hand and professional manners based on the rejection and stigma when, like in episodes of urgency , they are intervened on.

From the team here presented is obtained:

1. To properly identify the person, performing an integration of disperse information, which is separately handled in social, police, health and justice services.

2. To provide the services potentially involved ( Primary Care, emergency hospital services, hospital mental health units) a report with the known and confirmed data in order to ensure a better attention when needed.

3. To ensure that, when an urgent entry is made, usually involuntary, previous coordination activities between professionals have been hold in order to prevent people from leaking before admission process, to assure that hospital staff has a team that may provide information and also support the discharge.

4. To ensure proactive interventions to guarantee their overall health care , getting involved in the general health care, in medication supply and in accompanying to Primary Care queries.

With all of the above, we avoid risks of decompensation without treatment, of helplessness against third parties , and an uncoordinated and ineffective social and health response.

The intervention takes place in the streets, in case of homeless people, and in the homes of people living alone and unsupported.

The team is composed by professionals of direct intervention and exclusive attention to the program , supported by healthcare professionals with specific tasks identified in the program that belong to different devices, and that share the program as a network program coordinated by a responsible professional .

We believe , therefore, that to have a system of registration of these people , to incorporate the available information so that it facilitates their care by different professionals , to develop a work of continuous monitoring and approaching that allows intervention in situations of particular risk ( decompensation , intakes , aggressions … ) , affords a protection to these people that has a direct impact on an attention with more security and on a more dignified life .

We believe , moreover, that it helps to bring out about a change in the culture of the health organization, in order to to turn it into an intelligent organization based on trust rather than suspicion, this cultural change must be based on good records, on the risk management and on the involvement of patients and professionals.

Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
Effectiveness of the Patient Safety Practice
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
A baseline measurement before implementation of the reported practice was obtained
A measurement after full implementation of the reported practice was obtained
Evaluation of a “positive” effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation’s results
In phase of publication. The results will be presented at the European Congress of assertive community treatment Aviles of June 2012
577_WP4_INDICADORERS ETIC 2011_2012.doc
Health care context where the Patient Safety Practices was implemented
Mental health care
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
Mental health care
Successful implementation’s level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
Health care assistants
Social workers
Administrative support (secretary, clerk, receptionist etc.)
Clinical manager
Other or not relevant
Patient Involvement
Direct service user’s involvement as integral part of this Patient Safety Practice
Specification of the service users or their representatives’ involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives’ involvement takes place
There is no specified text here
Active seeking of service users’ opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users’ level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
List of sources where public information is accessible
Specific document sent to all organizations involved, to all computers on the network, to the family and user associations.
Implementation of the Patient Safety Practice
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Description of used incentives, if any.
Derivatives of the advantages of the self-organization of the availability of professionals with a high capacity for problem solving, providing spaces for coordination and monitoring of cases on an ongoing basis, the involvement of policy-makers in the solution of the problems, to support the training and research… All of them related to the motivation of workers and increasing the self-esteem of the staff with lower qualification within the system.
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Costs of the Patient Safety Practices
Completion of cost calculation related to this Patient Safety Practice
Total number of person days required to implement this Patient Safety Practice
Clinical staff: 3
External consultants: 0
Support staff: 2
Managerial staff: 1
Others: 0
Not relevant: 0
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: 1
External consultants: 0
Support staff: 2
Managerial staff: 1
Others: 0
Not relevant: 0
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice