What constitutes 'good practice' in early intervention for psychosis? Analysis of clinical guidelines.

Michelle Griffin‐Doyle,Ilina Singh,Paolo Corsico

doi:10.1111/camh.12229

Abstract

BackgroundEarly Intervention in Psychosis (EIP) services have been implemented with the dual aims of preventing harmful outcomes associated with early‐onset psychosis and improving prognosis. However, concerns have been raised regarding the ethical implications of involving young people in EIP services. One way to ensure high ethical standards and promote good practice in EIP delivery is through governance of clinical practice. This study aimed to investigate the normative dimensions of good practice in EIP through examination of clinical guideline documents published in England over the past 15 years.MethodsA total of 14 clinical guidelines and relevant policy documents for EIP were retrieved and analysed using a mixed inductive and deductive thematic approach. Themes were derived from the data itself, whereas the development of broader categories was performed through a constant comparison with the scientific literature describing ethical issues in EIP.ResultsEthical touchpoints of good practice in EIP included both procedural and substantive factors, which were seen to be interdependent and mutually constitutive. These ethical touchpoints were largely implicit in the documents analysed. Procedural requirements of EIP service delivery consisted of norms and rules pertaining to EIP service structure, adherence to codes of ethics, inclusivity, patient and family centredness and appropriate treatment provision. Substantive factors consisted of moral attributes that should be cultivated by healthcare professionals working in EIP: competency, empathy, sensitivity and trustworthiness.ConclusionsWe argue that, to ensure good practice in EIP, procedural and substantive ethical expectations embedded in EIP guideline documents should be made explicit in EIP service and care delivery. We suggest that the procedural and substantive factors highlighted in this paper contribute useful dimensions for the eventual evaluation of good practice in EIP services across England.

Highlights

In the last twenty years, Early Intervention in Psychosis (EIP) services have been introduced worldwide (Bird et al, 2010)
Initiative to Reduce the Impact of Schizophrenia (IRIS) and NICE guidelines for good clinical practice in EIP are consistent in identifying ethical requirements of service delivery as well as moral attributes of clinicians working in EIP
The present paper provides a review and analysis of the ethical arguments embedded in clinical guidelines for early intervention in psychosis in England

Summary

Introduction

In the last twenty years, Early Intervention in Psychosis (EIP) services have been introduced worldwide (Bird et al, 2010). Additional scientific and clinical guidance for EIP services is provided in England by the IRIS Network (IRIS, 2012), a professional network which has been active since 1998. This study aimed to investigate the normative dimensions of good practice in EIP through examination of clinical guideline documents published in England over the past 15 years. Results: Ethical touchpoints of good practice in EIP included both procedural and substantive factors, which were seen to be interdependent and mutually constitutive. These ethical touchpoints were largely implicit in the documents analysed. Conclusions: We argue that, to ensure good practice in EIP, procedural and substantive ethical expectations embedded in EIP guideline documents should be made explicit in EIP service and care delivery.

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