Early Intervention in Psychosis Summary Report
Current Service Delivery Models of EIP from the literature
Specialist standalone
An integrated, multidisciplinary, specialist team whose sole function is to deliver EIP (assessment, care planning, interventions and key working).
Team functions such as training and supervision occur within the team.
Population:
Suitable for densely populated urban areas of 250,000+. Larger populations would require multiple teams.
Evidence:
Evidence consistently shows that compared with standard care, specialist standalone services are an effective and cost-effective method to deliver EIP.
There is some evidence of savings within the NHS as well as wider societal savings, including criminal justice, education, employment and housing.
Benefits:
- less disengagement from mental health services
- small reduction in psychiatric hospitalisations
- small increase in global functioning
- increase in service satisfaction
- increased access to family interventions and other psychological services
- improved rates of functional recovery
- team collaboration which helps support staff wellbeing
- long term reduction in suicide risk
Limitations:
- long term benefits are still uncertain
- teams may become overstretched if outreaching to remote and rural areas
Hub and Spoke
A small team at the centre (hub) with other staff with distinct EIP roles placed away from the hub in CMHTs (spoke).
The number of spokes and staff time will depend on a range of factors. For example, an area with urban density surrounded by rural areas may require more staff at the hub and fewer in the spokes.
Population:
A small team at the centre (hub) with other staff with distinct EIP roles placed away from the hub in CMHTs (spoke).
The number of spokes and staff time will depend on a range of factors. For example, an area with urban density surrounded by rural areas may require more staff at the hub and fewer in the spokes.
Evidence:
NICE multidisciplinary expert opinion suggests that hub and spoke models may be more likely to provide services meeting EIP principles than augmented CMHTs. The model can be adjusted to suit local and regional requirements. For smaller areas, EIP services may be provided in part by collaborating through regional structures.
Benefits:
- staff can refine and develop specialist skills
- staff can concentrate solely on one client group
- staff can develop close relationships with other agencies
- ability to adjust model to suit local requirements
Limitations:
- limited evidence on effectiveness but perhaps some gain over generic services - for example, reduced hospital admissions compared with usual care and treatment
- may not be suitable for more remote or rural areas
- risk of staff isolation and limited clinical supervision
- lack of specialist therapies
- fluctuating case load and risk that staff are diverted to look after more generic caseload
Augmented Community Mental Health Team (CMHT)
Staff with a special interest or training in the management of psychosis situated within CMHTs with a generic caseload. Clinicians have ring-fenced time for EIP. There are regular meetings to co-ordinate care and treatment with a focus on outreach and work with carers and families, as well as access to psychological therapies.
Population:
There is a lack of evidence in the literature about populations which might be suitable for this model.
Evidence:
There is a lack of evidence about this model in the literature.
Benefits:
There is a lack of evidence about the limitations of this model in the literature.
Limitations:
There is a lack of evidence about the limitations of this model in the literature.
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