Discharges from an early intervention in psychosis service: The effect of patient characteristics on discharge destination

Ahmed, Shiraz; Peters, Kate Z.; Chakraborty, Nandini

doi:10.1111/eip.12552

Cited by 5 publications

(7 citation statements)

References 5 publications

(10 reference statements)

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“…They have closed their eyes and minds to the ongoing needs of their former patients and have somehow failed to notice one of the most worrying findings ever to emerge from mental health services research. In numerous areas across the UK, the most important factor in disengagement of people with insight-impairing illnesses from psychiatric care is planned and deliberate discharge by early intervention for psychosis teams (Ahmed et al, 2019;London Early Intervention in Psychosis Clinical Reference Group, 2016;Phillipson et al, 2014;Puntis et al, 2018Puntis et al, , 2021Turner & Rainey, undated). This may also be the case in Australia, Canada and the USA and, we fear, in other countries where well-intentioned policymakers have been influenced by the early intervention movement.…”

Section: Discussionmentioning

confidence: 99%

“…There is wide variation in the proportion of those who are discharged from all psychiatric services by early intervention teams in England. This has been happening to 47% of patients in Leicester and 55% in Derbyshire (Ahmed, Peters, & Chakraborty, 2019; Phillipson, Akroyd, & Carley, 2014). A recent article reveals that fully three-quarters were discharged by an inner-city London Trust after, on average, 28 months of care (Puntis, Whiting, Pappa, & Lennox, 2021).…”

Section: Discharge From Specialist Early Intervention Servicesmentioning

confidence: 99%

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Neglecting the care of people with schizophrenia: here we go again

Pelosi

Arulnathan

2023

Psychol. Med.

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Specialist early intervention teams consider clinician–patient engagement and continuity of care to be a driving philosophy behind the treatment they provide to people who have developed schizophrenia or a related psychotic illness. In almost all countries where this service model has been implemented there is a dearth of available data about what is happening to patients following time-limited treatment. Information on discharge pathways in England indicates that some early intervention specialists are discharging most of their patients from all psychiatric services after only 2 or 3 years of input. Some ex-patients will be living in a state of torment and neglect due to an untreated psychosis. In the UK, general practitioners should refuse to accept these discharge pathways for patients with insight-impairing mental illnesses.

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Section: Discussionmentioning

confidence: 99%

Section: Discharge From Specialist Early Intervention Servicesmentioning

confidence: 99%

Neglecting the care of people with schizophrenia: here we go again

Pelosi

Arulnathan

2023

Psychol. Med.

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“…It is the first to our knowledge to systematically apply QI methods to the challenge of care transition after FES. While there have been studies exploring referral patterns from FES in the UK (Ahmed et al, 2015;Ahmed et al, 2019), they did not directly examine patients' adherence to aftercare recommendations. This QI framework was well-suited to both implement a robust and sustainable data collection system, and support cycles of intervention to improve care transitions.…”

Section: Discussionmentioning

confidence: 99%

“…For example, some FES have clinicians accompany patients to their first session at the receiving clinic (Jones et al, 2020). As another example, in the UK, referrals from FES to primary care are quite common (Ahmed et al, 2019;Puntis et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Taking the next step: Improving care transitions from a first‐episode psychosis service

Gallagher

Ferrara

Pollard

et al. 2021

Early Intervention Psych

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Aims: First-episode services (FES) improve outcomes in recent onset psychosis, but there is growing concern about how patients fare after discharge from these timelimited services.Methods: A quality improvement approach (QI) was used to improve patient engagement in the discharge planning process (disposition), and successful engagement in care 3 months after discharge from the FES (transfer). Data from 144 consecutive discharges over 62 months are presented. A planning phase was followed by recurrent Plan-Do-Study-Act cycles (PDSA) that included the introduction of proactive efforts targeting disposition planning (with patients and families) and follow-up to facilitate transfer after discharge. Fisher's exact test was used to compare disposition and transfer outcomes across the QI phases.Results: This QI approach was sustained through a three-fold escalation in discharge volume. Transfer status at 3 months was significantly different between the pre-and post PDSA phases (p = .02). A greater proportion were confirmed transfers post-PDSA (54.3 vs. 37%), but of those with known status at 3 months, similar proportions were successfully transferred (76, 73%). Patients discharged post-PDSA were less likely to have unknown treatment status (26 vs. 51%). Disposition outcomes were also significantly improved post-PDSA (p = .03). Patients were more likely to engage with discharge planning (69.7 vs. 48.6%) and less likely to be lost to follow-up (13.8 vs. 25.7%), or to refuse assistance (11.0 vs. 20.0%). Conclusion:This QI approach offers a feasible way to improve disposition and transfer after FES and can be built upon in efforts to sustain functional gains in onward pathways.

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“…We found that the majority of EIP patients (83.5%) were discharged to primary care, which is substantially higher than in previous literature. 8,[15][16][17][18][19] Not only were more people being discharged to primary care, they were being discharged earlier: the median duration of EIP care was almost a year less than the 3-year stipulated treatment. This may reflect a combination of clinical judgement about need for treatment and pressure on case-load sizes.…”

Section: Discharge Pathwaysmentioning

confidence: 99%

Discharge pathways and relapse following treatment from early intervention in psychosis services

2018

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BackgroundEarly intervention in psychosis (EIP) services are the dominant service model in the treatment of first-episode psychosis. They are a time-limited intervention and little is known about discharge destinations and outcomes once EIP treatment has concluded.AimsTo understand discharge pathways and predictors of relapse in an EIP service.MethodWe collected data on all patients with an electronic health record treated by EIP services in Oxford Health NHS Foundation Trust in the UK between 12 January 2006 and 7 March 2017 (n = 701). Our primary outcomes were discharge destination at end of treatment and relapse.ResultsMost patients (83.5%) were discharged to primary care. Transfer to secondary care was associated with previous in-patient admissions (odds ratio (OR) = 1.92, 95% CI 1.54–2.39) and longer EIP treatment (OR = 1.04, 95% CI 1.03–1.06). Relapse rate was highest shortly after leaving EIP services. Relapse was associated with transfer to secondary care (hazard ratio (HR) = 2.75, 95% CI 1.75–4.31), higher deprivation (HR = 1.03, 95% CI, 1.01–1.05), a substance misuse disorder (HR = 1.81, 95% CI 1.01–3.26) and a comorbid diagnosis of a personality disorder (HR = 2.96, 95% CI 1.39–6.29).ConclusionsMost patients treated by the EIP service in Oxfordshire did not receive ongoing mental healthcare from secondary mental health services. We identified high deprivation and those with substance misuse problems or personality disorders as EIP populations with a high risk of relapse.Declaration of interestNone.

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Discharges from an early intervention in psychosis service: The effect of patient characteristics on discharge destination

Cited by 5 publications

References 5 publications

Neglecting the care of people with schizophrenia: here we go again

Neglecting the care of people with schizophrenia: here we go again

Taking the next step: Improving care transitions from a first‐episode psychosis service

Discharge pathways and relapse following treatment from early intervention in psychosis services

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