Improving access to Early Intervention in Psychosis (EIP): the 2-week wait for cancer comes to psychosis

Abstract

Early Intervention in Psychosis (EIP) services aim to rapidly initiate specialist packages of care for those people newly experiencing symptoms. The intention of such rapid engagement is to mitigate the negative effects of a prolonged duration of untreated psychosis. Aiming to achieve a ‘parity of esteem’ between mental and physical health, a new target was introduced by the National Health Service (NHS) England, where 50% of new referrals were expected to receive a concordant package of care within 2 weeks from the National Institute for Health and Care Excellence. A baseline assessment in late 2014 found that just 21% of all referrals received and accepted met this target within the EIP Team for the North-East London NHS Foundation Trust. This project sought to improve the team’s performance, seeking input from all team members and using an iterative process with the primary aim of meeting the target ahead of its roll-out. It was determined that the relatively high number of inappropriate referrals (34% at baseline) is a key causative agent in delaying staff from processing eligible cases in a timely fashion. These are defined as referrals which do not meet basic eligibility criteria such as no previous treatment for psychosis. Interventions were therefore designed targeting three domains of improving staff awareness of the new target, improving efficiency by changing the case allocation process and improving the referral pathway for external sources. The impact of these changes was re-evaluated over two cycles beyond baseline. By the final cycle, 62% of new referrals were seen within 2 weeks, while inappropriate referrals declined to just 3%. The multi-interventional nature of this project limits its generalisability and further work should be carried out to identify those changes that were most impactful. Nevertheless, focused targeting of the referral pathway may prove to be of benefit to other EIP services struggling with lengthy wait times.

Sociodemographic and clinical predictors of delay to and length of stay with early intervention for psychosis service: findings from the CRIS-FEP study

“…In another service evaluation at the North-East London NHS Foundation Trust, Singh et al (2018) set out to increase the speed at which referrals were processed through the early intervention service to meet the Access and Waiting Time Standard. Using multiple interventions, including improving staff awareness, changing the case allocation process, and improving the referral pathway, the proportion of patients seen and assessed within 2 weeks rose from 21 to 62% [ 64 ]. However, the referral sources were mainly from statutory organisations, e.g., mental health services, psychiatric liaison services, criminal justice/probation service, and primary care.…”

Three-year outcomes and predictors for full recovery in patients with early-stage psychosis

“…Accumulating evidence indicates an association between a shorter DUP and FEP recovery 12,14,15,17,18 . The DUP can be reduced by early intervention 77 and by a 2-week referral-to-treatment target for psychosis 78 . Considering that the DUP in the present study was 14.1 ± 26.3 months, more active awareness campaigns and the establishment of effective referral systems are required.…”

Examining the effects of national initiatives to improve the physical health of people with psychosis in England: secondary analysis of data from the National Clinical Audit of Psychosis

“…Typically, these services advocate a more 'intensive' programme of intervention, with a focus on relatively smaller case-loads, proactive engagement and an increased frequency of contact. [35][36][37][38][39] Although this approach is primarily intended to address psychiatric symptoms, multiple sources have suggested additional benefits for patients' overall health, including increased levels of screening for physical health problems. 40 EIP services may, therefore, have been better placed to implement changes resulting from the national initiatives rolled out in 2014.…”