The Early Intervention in Psychosis model is a comprehensive and evidence-based approach to providing care and treatment for people experiencing first episode psychosis. Early Intervention in Psychosis services typically offer a range of interventions including:
- pharmacotherapy
- psychological therapies
- family support
- vocational assistance
- peer support
The primary aims of Early Intervention in Psychosis are to reduce the duration of untreated psychosis with timely access to assessment and treatment, improve clinical and functional outcomes, and to promote recovery and social inclusion.
Why develop an Early Intervention in Psychosis Service?
There is a well-established evidence base within the United Kingdom and internationally that early identification and intervention for first episode psychosis leads to improved outcomes and is more cost-effective than standard care.
There is also evidence that Early Intervention in Psychosis can be successfully implemented beyond a stand-alone Early Intervention in Psychosis service and that this has shown to be the case even in challenging contexts such as rural areas. This is particularly relevant to the development and delivery of Early Intervention in Psychosis services in Scotland.
Establishing a specialist service for this client group provides an opportunity to design a fit-for-purpose service that has the flexibility to meet the unique needs of service users, rather than requiring a person to navigate their own way through existing services.
The experiences of people who have had contact with Early Intervention in Psychosis pathfinders, including family members and carers, are shared in the case studies and resources as part of this guide. Other beneficial outcomes demonstrated by pathfinders include a reduction in re-admissions to hospital. Pathfinder outcomes are shared in more detail in the end of phase reports in the resources section.
EIP Early Intervention in Psychosis is effective because it is:
- Trauma-informed
- Cost-effective
- Provides resources to the most marginalised groups
- Contributes to physical health parity
- Connects with the community
Lived experience
Here’s what people with experience of psychosis think of first episode psychosis:
- “I want my family to be involved with treatment”
- “We need to raise awareness around the illness and remove stigma so that more people can be open to Early Intervention in Psychosis ”
- “People with psychosis need a lot of reassurances and comfort… you need person-centred planning focusing on patient goals”
To read from a clinician working in an Early Intervention in Psychosis service, see Clinical Psychologist Katie Whyte’s blog from January 2021: Early Intervention for Psychosis.
The design and development of a service that is fit-for-purpose relies on a good understanding of current service user needs, NHS and wider system provision.
Early Intervention in Psychosis End of Phase Report Resources
The following resources will help you understand the development of Early Intervention in Psychosis in Scotland so far:
Webinars from the Early Intervention in Psychosis programme are available on the Early Intervention in Psychosis Programme website: National network events page.
Understanding Early Intervention in Psychosis
It is important that the whole team understand that Early Intervention in Psychosis requires a fundamentally different approach to care and treatment than traditional approaches; one that emphasises engagement both with the person and their family/friends/carers, recovery, developmental stages and a person’s social context.
The resources provide further background information on the development of Early Intervention in Psychosis services in NHS England and how Early Intervention in Psychosis Services can meet the needs of young people.
Developing Early Intervention in Psychosis Resources
Early Intervention in Psychosis ethos
Early Intervention in Psychosis services are notable for having a unique team culture and ethos, which draws upon the key principles of person-centred care, embracing diagnostic uncertainty, working with families, and focusing on recovery. This is something which develops as the team capability and service grow.
Conceptual framework for personal recovery (CHIME)
A person-centred way of working is central to the Early Intervention in Psychosis ethos, with the Early Intervention in Psychosis team working flexibly and adapting to the person and family’s needs. The involvement of people within care and treatment is guided by the conceptual framework for personal recovery ‘CHIME’
Connectedness
- Peer support and support groups
- Relationships
- Support from others
- Being part of the community
Hope and optimism
- Belief in possibility of recovery
- Motivation to change
- Hope-inspiring relationships
- Positive thinking and valuing success
- Having dreams and aspirations
Identity
- Dimensions of identity
- Rebuilding or redefining positive sense of identity
- Overcoming stigma
Meaning in life
- Meaning of mental illness experiences
- Spirituality
- Quality of life
- Meaningful life, social roles and goals
- Rebuilding life
Empowerment
- Personal responsibility
- Control over life
- Focusing on strengths
If psychiatry input is sessional or provided through the Community Mental Health Team, it may take longer for those colleagues to buy in to the team ethos and culture. Dr Rajeev Krishnadas has written an educational session on pharmacological management of first episode psychosis, which also covers the importance of Early Intervention in Psychosis services.
The Early Intervention in Psychosis programme report on Early Intervention in Psychosis ethos shares learning and narratives from the pathfinder sites, exploring how a team culture is built and the impact of Early Intervention in Psychosis ethos on service users and staff.
Forming part of the Scottish Patient Safety Programme, Essentials of Safe Care is a practical package of evidence-based guidance and support that enables Scotland’s health and social care system to deliver safe care for every person, within every setting, every time.
This also aligns with the Scottish Approach to Change, which aims to support health and social care services to deliver high quality change. When thinking about the ethos of the team, person centred care and leadership and culture will be pertinent to staff behaviours to ensure patient safety is also considered.
Activity: Paths to recovery
Resources
Understanding current provision and first episode psychosis journeys
One way of assessing current provision is to gather local data on people identified as having experienced first episode psychosis in existing services, for example which services they came into contact with, how soon they were identified and when they started treatment.
A key aspect of improving outcomes for people experiencing first episode psychosis is to reduce the duration of untreated psychosis, defined as the period from the onset of psychotic symptoms to the start of treatment.
The Scottish Government’s mental health quality indicator (T5) has set the expectation that people presenting with first episode psychosis should be offered treatment within 14 calendar days from referral. Data on current service provision for people with first episode psychosis can provide a baseline measure to later assess the impact of new Early Intervention in Psychosis services.
The Early Intervention in Psychosis Phase 1 report identified inconsistencies in coding used to identify cases of first episode psychosis across Scotland, and consequently there is limited data that could help understand demand, access, and quality of services across Scotland.
Activity: complete the last 10 patients activity to support gathering your baseline data.
You may want to consider gathering data on your last 10 patients to understand your current service provision. This will assist in understanding the number of people who present to local services with first episode psychosis and can then be used to estimate monthly/annual caseloads for your service. Quality improvement or business intelligence support within your local area can help with obtaining this data. The case study below details the approaches taken by the original pathfinder sites around collecting baseline data. Read more about collecting baseline data from a case study with the pathfinder sites.
Gathering Baseline Data Resources
Evidenced based psychological therapies recommended for people with psychosis
A key part of the Early Intervention in Psychosis model is the timely access to evidenced based psychological therapies for psychosis, as detailed in the Scottish Intercollegiate Guidelines Network Guideline 131: Management of Schizophrenia and the Matrix evidence table.
These are:
- Behavioural Family Therapy – a practical, structured intervention aimed at developing understanding and communication within the family
- Psychosocial Interventions for Psychosis - a recovery focussed approach including relapse prevention
- Cognitive Behavioural Therapy for Psychosis – aimed at reducing distress and improving functioning
Prompt questions:
- What is the current need and provision of services for people with psychosis?
- What is the current awareness and interest in Early Intervention in Psychosis, amongst staff within your health and social care partnership?
- What can you build on and what might make it difficult to set up an Early Intervention in Psychosis service in your area?
- What existing capabilities and capacity does the health and social care partnership have to deliver evidence-based therapies for psychosis?
Project management
Project management and administrative support will need to be arranged within existing capacity. As a new EIP Early Intervention in Psychosis team, it will be important to consider all aspects of project management including:
- project plan with timescales and dependencies
- setting up implementation and lived experience groups and peer learning spaces
- schedule of activities, and
- finance trackers.
The pathfinders used a phased approach to establish their services,and the experiences and learning from this were used to developed the staged approach detailed below:
Initial set up
- Early Intervention in Psychosis service model: identify a suitable model and location for your service
- Senior management engagement
- Stakeholder engagement: organise implementation group
- Workforce planning and core team recruitment
- Setting up the service: baseline data
- Setting up the service: current first episode psychosis journey and treatment
- Stakeholder mapping
- Lived experience and third sector input to co-design
- Service design training sessions
- Consider training needs
Preparing for launch
- Stakeholder engagement: lived experience reference group
- Develop a communications plan and promote the service
- Develop referral, management, treatment, and discharge pathways
- Data collection readiness session
- Allocate additional roles
The phased approach listed above isnot prescriptive and will be defined by the circumstances of your local area, the resources and staffing available to you. The guide is structured around these timescales for guidance purposes only, to help you easily navigate to the relevant section of the guide and for you to mark progress as you prepare for service launch.
It is also important to note that recruitment can substantially impact timescales. Using secondment or recruiting internally can make the process faster. However, if you are recruiting externally, this needs to be taken into consideration along with your timelines for service development and launch.