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Aim: This study sought to develop a methodology to measure the integration of substance use treatment within five existing assertive outreach (AO) teams in Birmingham, UK. Changes in the way teams approach and discuss drug and alcohol problems amongst clients with severe mental health problems were anticipated. This was assessed at team meetings, through clinical sessions and case notes. The impact of change in team practice was also measured at the level of service users by assessing psychiatric symptoms, engagement, amount of substance used, and conviction ratings of positive substance-related beliefs.Method: Each team were provided with training and supervision to deliver cognitive behavioural integrated treatment (C-BIT). This aimed to increase awareness of the relationship between psychosis and problem substance use and provide skills to manage these difficulties. Data was collected at intervals over a 36 month period.Results: Staff within teams increased in self reported confidence and skills to deliver C-BIT and these gains were maintained over time. Findings suggest that following training, integration was achieved to a degree and changes in teams practice were observed. Improvements in client engagement and reduction in alcohol intake and positive alcohol-related beliefs were also noted but occurred regardless of team training.Conclusions: Training and supporting AO staff to use an integrated treatment approach is well received and produces lasting changes in confidence and practice. Whether this can go on to impact upon client outcome is yet to be established. [ABSTRACT FROM AUTHOR]

Twenty-one people diagnosed as schizophrenic by SCAN and hearing auditory hallucinations were assessed for depression and the nature of the voice content and beliefs about these using the Beck Depression Inventory, Beliefs About Voices Questionnaire, the Cognitive Assessment Schedule and the Topographical Voices Scale. Examples of content were rated as either derogatory or nonderogatory by the author and a blind rater, with a kappa of 0.6. Depression was linked to both derogatory voice content (p=0.0004) and malevolent beliefs and/or resistance coping strategies (p=0.0176) as well as voice intrusiveness and loudness. There was a positive relationship between SCAN depressive and positive symptoms (p=0.013). A cognitive-behavioural model is proposed and it is recommended that schizophrenic hallucinators with derogatory content and/or malevolent beliefs are screened for depression and suicidal ideation. [ABSTRACT FROM AUTHOR]