Ethical aspects of assertive outreach

Assertive outreach is a specialized way of delivering community mental health in the UK and elsewhere. Ethical problems arise from the fact that assertive outreach is supposed to promote independence in a non-engaging individual while at the same time forcing him or her to engage with mental health services. The ethical analysis of assertive outreach presented here is based on Beauchamp’s ethical grid and refers to the four categories: beneficence; harm; autonomy; and justice. This is evaluated in light of newer research on the effectiveness of assertive outreach in the UK. Two case examples are presented, illustrating the practical difficulties with this. Ethical dilemmas are highlighted (persistence versus coercion; public protection versus risk aversion; empowerment versus negligence; support versus harassment) and the importance of ethical considerations in the future development of assertive outreach is stressed.