Early Intervention In Psychosis Teams Research Articles

Service users' views of moving on from early intervention services for psychosis

Lester et al's paper is timely.1 Many early intervention in psychosis (EIP) teams have been in action for over 3 years and are refining discharge pathways to primary care. This interface is not just with colleagues but now also with commissioners. While there is robust economic evidence for EIP, this perhaps sits outside the regular reading of most GPs.2 This interface needs active management and should not be relied on to grow organically. Every interaction with GPs should name the team and provide opportunity for shared learning, enhanced by the many leaflets covering this area.3 There is a need to help GPs to understand what patients have been experiencing for the proceeding 3 years and not just to advise on subsequent management. In a world of ever changing services it is particularly important that they can be supported to navigate their way back in and EIP teams would tend to maintain responsibility for this, sometimes necessitating a brief period of re-engagement to do so. This is added value from an economically justified team. GPs are often left with a client who is still on medication and are quite reasonably asking for how long they may continue, when medication can be safely stopped, and what the considerations and risks in doing so may be. There is a concern that vocational aspects, that are particularly valued by clients, may be among the hardest to access from primary care.

Service‐users’ experiences of an early intervention in psychosis service: An interpretative phenomenological analysis

Previous research regarding Early Intervention in Psychosis (EIP) services has mainly adopted quantitative methodologies, in order to study the effectiveness of EIP services. Research studies that have explored service-users' experiences of EIP services are small in number. This research aimed to explore service-users' experiences of being in contact with an EIP service, its impact of their experience of psychosis and current life situation. Interpretative Phenomenological Analysis (IPA) was used to conduct an in-depth qualitative study of a small sample of EIP service-users, in order to explore their experiences of being in contact with the service. Flexibly guided interviews were conducted with eight service-users who had been receiving a service from an EIP team for more than 2 years and were recruited using a purposive sampling method. Verbatim interview transcripts were analysed using IPA. Five super-ordinate themes, developed from the analysis, are discussed in sections: Stigma, Relationships, Understanding the experiences, Sense of agency, and Impact on sense of self. Sub-themes of these super-ordinate themes are also discussed. The themes developed from the analysis were envisioned as representing an overarching theme of 'A personal journey of recovery', which was influenced by participants' involvement with the EIP service. Clinical implications include the need for EIP services, as with other mental health services, to find ways to promote recovery and create opportunities for agency and control. Future research directions are also discussed.

Social inclusion and recovery for young people with first episode psychosis: a London survey of early intervention in psychosis teams and their links with the further education system

This article is an account of an ambitious change management effort across the inter‐organisational divide of health and education. It focused on improving the relationships between staff in health and education sectors, to enable people to work together with a sense of shared purpose and joint vision: to get young people with early psychosis back into education and training, and to keep them there. It involved working on people's mindsets, and discarding long‐held negative expectations of what mental health service users can achieve. The project is based in London.

The experience of working with dual diagnosis in an early intervention in psychosis team

This paper presents the outcomes of a small qualitative study investigating the experience of mental health practitioners working with dual diagnosis in an early intervention in psychosis (EIP) team with a focus on the use of a specifically developed screening tool. Interviews were conducted with mental health professionals who were employed as care co‐ordinators within an EIP team. Grounded theory was adopted as a method for making sense of the data obtained. Six themes that emerged from the data are described: the importance of the cycle of change in treatment planning; service accountability and responsibility; the nature of psychotic illness; assumptions about substance use; confidence; and using the tool as part of the recovery process. These themes were discussed in relation to research surrounding psychosis, substance use and screening methods.Despite identifying the importance of a more integrated method of working with this complex service user group, gaps remain in practice. Modifications to the screening tool are recommended and a need for substance‐use‐specific interventions training for practitioners working within EIP services is identified.

Who should swing the stethoscope? An audit of baseline physical examination and blood monitoring on new patients accepted by an early intervention in psychosis team

It has been established that patients with severe mental illness are at increased risk of physical illness and that physical health screening should be performed when an individual experiences a first episode of psychosis. The aim of the audit was to examine how physical health screening was achieved in the real world of an early intervention in psychosis (EIP) service in Scotland. Of particular interest was considering if primary or secondary care were more effective in providing specific physical health assessment for those presenting to the service. A case note audit was performed. The audit shows that physical examination and blood tests were being completed in the majority of service users under the care of the Esteem service. However, an unacceptably high number were not undergoing sufficient initial screening for metabolic syndrome or having baseline monitoring prior to commencing antipsychotic medication. Our results suggest that relying on primary care to provide physical health screening was not an effective approach in a population experiencing first-episode psychosis. Having a psychiatrist motivated to perform physical health screening within the EIP team may help to improve the uptake of physical health screening. Strategies to improve physical health screening in EIP services are discussed.

Traffic Lights

PurposeThe current risk management system for community mental health patients in England is based around the Care Programme Approach (CPA). This system is not responsive to changes in risk for community patients. This paper aims to introduce a practical system to manage risk that has been developed for an Early Intervention Service in East London on the basis of need.Design/methodology/approachCoding of red, amber and green is associated with specific criteria agreed by all disciplines in the team. The change of a code leads to a rapid change in risk level and management. An agreed clinical and non‐clinical action plan leads to a whole team response. The limitation of use is dependent on the size of the case load and the number of clinical staff attending a daily clinical briefing.FindingsZoning according to the traffic lights system could complement the CPA system and support a clinical governance structure utilising a whole team response.Research limitations/implicationsThe risk management system described has not been tested empirically. Currently it has been used in early intervention mental health teams but will need to be adapted for other teams with bigger case loads.Originality/valueThis practical risk management system is aligned with the statuary CPA requirements. A dynamic and flexible management of risk is central to early intervention in psychosis teams but the risk management system described can suit any community mental health team and fits well with the distributed responsibility model of functionalised teams according to new ways of working.