Early Intervention in Psychosis Summary Report
Needs assessment learning
All 14 NHS boards provided information, through interviews, about their current service provision. They identified areas of good practice and challenges, highlighting significant variation across Scotland.
Challenges around service provision were raised:
- lack of identified systems for involving people with lived experience in service design and delivery
- confidentiality concerns which prevent family involvement
- lack of leadership buy-in
- limited links between primary and secondary care, and
- variable links with other key stakeholders including third sector or social care.
- general funding challenges for mental health services
- absence of ring-fenced resources for EIP
- potential impact on other mental health services of diverting resources to EIP
- fragmented governance and management structures
- challenges with staff recruitment and retention
- over-reliance on temporary and locum staff
- inadequate access to specialist training and clinical supervision
- high caseloads and lack of capacity, and
- increased need linked to COVID-19.
- lack of data to understand demand, access, and quality
- long waiting times for psychological therapies
- structural barriers to multidisciplinary team working
- EIP not reflected in strategic plans
- difficult transitions from CAMHS to adult services
- limited access to family therapy
- variation in referral pathways
- absence of dedicated pathways and services
- impact of COVID-19 on quality of care and staff wellbeing, and
- stigma prevents people from seeking help early.
Good practice captured from needs assessment learning
- Shetland's CMHT has a strong focus on team working and linking with other parts of the service. They have daily 20-minute meetings to discuss urgent cases that may have come in overnight. A community mental health nurse attends a GP handover meeting every Friday evening and Monday morning, and the team are involved in weekly virtual ward rounds with adult inpatients.
- In Forth Valley, the multidisciplinary team (medical, nursing, OT, art therapies) and social work are co-located. There is a day unit team, and pre-treatment screening can take place in the same location with a full team on site. A citizen’s advice worker comes in once a week. There is a high familiarity and consistency of staff for people. Staff can also support people during additional appointments outwith health as it is in the same building.
- Argyll and Bute use a recovery model to guide their ethos with a focus on working in partnership with people who have lived experience, their families and carers. Their focus is on recovery and empowerment.
- Fife Employability Access Trust have individualised placement support staff who offer a range of interventions including cognitive remediation therapy, employment skills courses, training for employers, and individual placement support services. Working with people who have lived experience, they liaise with employers to identify goals for work, transferrable skills and support people into employment.