Early Intervention for psychosis in the time of COVID-19
Written by Dr Suzy Clark, Consultant Clinical Psychologist Clinical Lead at Healthcare Improvement Scotland in January 2021.

Wednesday morning at the first clinical meeting of 2021. I clicked the MS TEAMS link and suddenly see 12 colleagues faces appear; how familiar remote working has become. The weekly get together with the whole team is even more highly valued for the connectedness it provides.

Psychosis was already on the increase when the pandemic hit and there have been noticeably more new presentations of psychosis since last March.

Why ?

Many people have had important life transitions such as leaving home to go to university, thwarted. Social networks are diminished and people miss the lack of peer group contact and structure to their day. It takes longer for people to get referred and the psychosis is often more severe by the time they do.

Impact of COVID-19

For an EI Service the requirement to be socially distanced and not to have face to face contact is the antithesis of how it would normally operate. Accessibility and engagement, getting alongside the service user for a coffee or a walk or to help with housing is a key aspect to the early stages of engagement and has been much more difficult during Covid. Many of the interventions the service would routinely offer such as groups; family events for carers; face to face contacts with clinicians were discontinued during Covid. Staff were sent home abruptly and a rota provided cover every day in the office. We lost our clinical rooms to support new Mental Health Assessment units and clinical work was focused on contact with people with acute psychosis and at risk of admission. That meant suspending contact with people that you had regular contact with for a month or two. The energy and adrenalin that helped with the initial lockdown wore off and over time staff reported missing the camaraderie of colleagues. Fortunately the service had been piloting digital delivery and the pace of this accelerated. Clinicians adapted quickly to the use of “Near me” and learnt to share documents and still hold psychologically informed team formulation discussions online.

Many service users surprised themselves with how well they coped during lockdown finding the skills they had learnt to help with their mental health also helped with general wellbeing, such as regular fresh air/ exercise, planning your day in chunks of time and not giving yourself a hard time if you are not that productive. For others, it has been a very difficult time. Service users missed the face to face contact but recognised the need for remote working and some reported benefits, for example, fitting sessions around work commitments and being more able to talk about difficult things at a distance.

Remobilising

Gradually more routine work was remobilised; supervision structures, Behavioural Family Therapy, Family & Friends support groups and psychological therapy restarted online in summer and are working well. A new peer support worker started, (probably the hardest time ever to start a new job) and they have been a great addition to the service. There were some inevitable hiccups with the technology and the recent improved functionality of MS TEAMS has helped enormously. Attendance has been good: staff, service users and carers appreciate the opportunity to connect online.

The Future

Undoubtedly digital service delivery is here to stay, although I anticipate a blended approach going forward. Being in the room with a highly distressed person to help them feel less alone will never be replaced. As for the future, walking groups and cycling groups are planned for the spring and I think we will all take forward a renewed appreciation of the value of social connections for well-being and recovery.