About Early Intervention in Psychosis
There is significant variation in the provision of care and treatment for people with first episode psychosis across Scotland, with only one Early Intervention in Psychosis (EIP) service (Esteem in NHS Greater Glasgow and Clyde), and most care and treatment delivered by community mental health teams (CMHTs).
The evidence is clear, intervening early with the right set of approaches delivered in the right way will lead to significantly improved outcomes for people. The needs assessment highlighted that most services are not consistently delivering all of the core, evidence-based components of EIP.
Examples of Early Intervention in Psychosis services
The benefits of an EIP approach are clear:
- randomised controlled trials have shown that, compared to treatment as usual, EIP services lead to reduced hospitalisation rates and length of stay, decreased symptom severity, and improved social functioning
- real world implementation of EIP services matches these benefits: people with lived experience of psychosis who accessed EIP services were more likely to be in a relationship, and had a tendency toward lower mortality and fewer prescriptions of antipsychotic medication, and
- while these approaches might cost more initially, the reduced in-patient care, higher vocational recovery, and improved quality of life lead to better economic outcomes in the long term.
This case study details the pathfinder sites’ experience and key learning points regarding collecting baseline data.
- Our second case study identifies some of the facilitators and challenges experienced when engaging with stakeholders, and the ways these were met by the pathfinder sites.
Key components of Early Intervention in Psychosis
EIP is characterised by core components of values, for example, connectedness, hope, identity, meaning and empowerment (CHIME Framework); interventions, which are supported by evidence and outlined in SIGN (Scottish Intercollegiate Guidelines Network) and NICE (National Institute for Health and Care Excellence) guidance and the literature; and service design, which describes the key characteristics of effective services.
Service model choice will be strongly influenced by both the evidence base and local context and should be co-designed with people with lived experience. An Early Intervention in Psychosis service is one that includes the following core components.
- recovery focus
- developmentally and culturally sensitive
- synergistic and collaborative
- human rights-based approach
- trauma informed, and
- family engagement.
- biopsychosocial interventions
- CBTp and other psychological interventions
- family interventions
- low dose antipsychotic medication
- regular medication review
- annual physical health reviews
- support for carers
- treatment of co-morbidities
- vocational support, and
- housing support.
- quick access to early treatment
- measurement of duration of untreated psychosis
- low caseloads
- embracing diagnostic uncertainty
- integrated multidisciplinary working
- staff with ring-fenced time
- three-year duration
- assertive outreach, and
- peer support.