Developing early intervention services in the NHS: a survey to guide workforce and training needs

Abstract

Aims and Method We conducted a questionnaire study to establish the incidence, specialist staff availability, treatment provision and socio-demographic profile of patients with first-episode psychosis referred to all adult and child and adolescent community mental health teams in south and west London. Results All 39 teams completed the questionnaire, identifying 295 cases of first-episode psychosis (annual incidence 21/100 000/year) referred in the year 2000. Teams manage to engage most patients with first-episode psychosis. A total of 73% of cases of first-episode psychosis were on some form of Care Programme Approach. However, many teams did not have adequately trained staff to provide psychosocial interventions. Even where such staff were available, care was focused mainly on monitoring medication and risk assessment, with only half the teams providing psycho-educational programmes and only a quarter offering individual cognitive–behavioural therapy to those with first-episode psychosis. Clinical Implications Establishing early intervention services nationwide will require significant new resources, including specialist trained staff, which could prove difficult to provide in inner-city areas. Rather than a single, uniform service model, several models of early intervention services based on locally determined need might be more realistic and appropriate, and also allow research into their relative efficacy.

The NICE schizophrenia guidelines: the challenge of implementation1

“…Interventions that do have strong evidence of efficacy may not be available in routine practice (Singh et al, 2003). The task of local implementation strategies will be to seek to increase the availability of interventions with a good evidence base while at the same time integrating these into the routine care, continuity and wider biopsychosocial approach that a condition such as schizophrenia demands.…”

First-episode psychosis: primary care experience and implications for service development

“…Therefore the local model has to be flexible and needs based. 18 Questionnaire surveys of clinical practice do not necessarily provide an accurate picture of clinical process and activity. Care professionals completing the questionnaires might feel that their services are being scrutinised and provide 'acceptable answers'.…”

“…Care professionals completing the questionnaires might feel that their services are being scrutinised and provide 'acceptable answers'. 18 This study questionnaire was confidential and focused on GPs experience, views and expectations. This is likely to help avoid or at least minimise such a tendency.…”

Early intervention in psychosis: obstacles and opportunities

“…Intervention is delayed until a crisis occurs, when the first intervention becomes a coercive contact involving involuntary admission to wards with disturbed, chronic and disabled patients, setting the young person on a long-term course of disenchantment with mental health services. Even where services are willing to engage with patients, community mental health teams are often underresourced, poorly trained in psychosocial interventions and forced to prioritise statutary obligations over clinical interventions (Singh et al, 2003;Yung et al, 2003).…”

“…ETHOS was developed following a survey of the existing service provision for first-episode psychosis in south and west London, which revealed poor provision of effective interventions by community services (Singh et al, 2003). There were no new resources for service development, but each borough agreed to contribute the equivalent of one whole-time care coordinator, and the mental health trust provided support staff and a half-time vocational worker.…”