Aims and method The impact of flexible assertive community treatment (FACT) has been observed in people previously supported by assertive community treatment (ACT) teams, but its effect on those previously with a community mental health team (CMHT) has not been studied in the UK. An observational study was conducted of 380 people from 3 CMHTs and 95 people from an ACT team, all with a history of psychosis, following service reconfiguration to 3 FACT teams.Results People previously with a CMHT required less time in hospital when the FACT model was introduced. A smaller reduction was observed in people coming from the ACT team. Both groups required less crisis resolution home treatment (CRHT) team input.Clinical implications FACT may be a better model than standard CMHT care for people with a history of psychosis, as a result of reduced need for acute (CRHT and in-patient) services.

SUMMARYCurrent understanding of psychosis development is relevant to patients' clinical outcomes in mental health services as a whole, given that psychotic symptoms can be a feature of many different diagnoses at different stages of life. Understanding the risk factors helps clinicians to contemplate primary, secondary and tertiary preventive strategies that it may be possible to implement. In this second article of a three-part series, the psychosis risk timeline is again considered, here focusing on risk factors more likely to be encountered during later childhood, adolescence and adulthood. These include environmental factors, substance misuse, and social and psychopathological aspects.LEARNING OBJECTIVES:After reading this article you will be able to: •understanding the range of risk factors for development of psychotic symptoms in young people and adults•understand in particular the association between trauma/abuse and subsequent psychosis•appreciate current evidence for the nature and strength of the link between substance misuse and psychosis.DECLARATION OF INTEREST:None.

SUMMARYPsychosis is a complex presentation with a wide range of factors contributing to its development, biological and environmental. Psychosis is a feature present in a variety of psychiatric disorders. It is important for clinicians to keep up to date with evidence regarding current understanding of the reasons psychosis may occur. Furthermore, it is necessary to find clinical utility from this knowledge so that effective primary, secondary and tertiary preventative strategies can be considered. This article is the first of a three-part series that examines contemporary knowledge of risk factors for psychosis and presents an overview of current explanations. The articles focus on the psychosis risk timeline, which gives a structure within which to consider key aspects of risk likely to affect people at different stages of life. In this first article, early life is discussed. It covers elements that contribute in the prenatal and early childhood period and includes genetic, nutritional and infective risk factors.LEARNING OBJECTIVESAfter reading this article you will be able to: •give an up-to-date overview of psychosis risk factors that can affect early life•describe some important genetic risk factors•understand more about the role of environmental factors such as nutrition and infection.DECLARATION OF INTERESTNone.

SUMMARYPsychosis is a recognised feature of several psychiatric disorders and it causes patients significant distress and morbidity. It is therefore important to keep knowledge of possible risk factors for psychosis up to date and to have an overview model on which further learning can be structured. This article concludes a three-part series. It gives a review of evidence regarding common pathways by which many risk factors come together to influence the development of psychosis and finalises our suggested overview model, a psychosis risk timeline. The three primary pathways considered are based on the major themes identified in this narrative review of recent literature and they focus on neurological, neurochemical and inflammatory changes. We link each back to the factors discussed in the first and second parts of this series that alter psychosis risk through different mechanisms and at different stages throughout life. We then consider and summarise key aspects of this complex topic with the aim of providing current and future clinicians with a model on which to build their knowledge and begin to access and understand current psychosis research and implications for future preventive work.LEARNING OBJECTIVESAfter reading this article you will be able to: •give an overview of common pathways thought to link identified risk factors with psychosis development•understand neurochemical, neurostructural and inflammatory changes associated with psychosis•demonstrate increased knowledge of possible preventive strategies.DECLARATION OF INTERESTNone.

Aims and methodService user involvement in the development of services is a fundamental aim of the National Health Service (NHS). However, a structured and quantifiable approach to their involvement in the recruitment of NHS staff is still lacking. In this study, we used service-user focus groups within a therapeutic community for people with personality disorder in order to develop the Service User Informed Tool for Staff Selection (SUITSS).ResultsWe enabled service users to develop SUITSS as a Likert scale with which to define relevant staff characteristics and rate applicants according to them, informing the staff-selection process. The tool has a semi-quantitative format that allows to test whether applicants with higher ratings are actually appointed by selection panels or not.Clinical implicationsThis new tool provides an approach to enhancing service user contributions to staff recruitment. It may be adapted and refined for use in a range of services, with local input from service users, following the approach described here.