KNOWLEDGE
EARLY INTERVENTION IN PSYCHOSIS
To be aware and able
Efforts to raise awareness about mental health and psychosis in North East
Hampshire and Surrey aim to help young people access support earlier and
so achieve better outcomes. Sarah Amani outlines findings from the project
Psychosis affects 1–3% of the
population. An estimated 6,900 young
people aged 14–35 years old will deal
with an emerging psychosis in the UK1.
Each person’s experience of psychosis
will be different and therefore treatment
needs to be tailored according to each
individual’s experiences and needs. The
typical signs of psychosis include:
UÊ i>Àˆ˜}]ÊÃiiˆ˜}ʜÀÊÓiˆ˜}Ê̅ˆ˜}ÃÊ̅>ÌÊ
other people do not
UÊ /…ˆ˜Žˆ˜}Ê>˜`ÊLiˆiۈ˜}Ê̅>ÌÊ
everything is about or related to you
UÊ iVœ“ˆ˜}Ê«ÀiœVVÕ«ˆi`Ê܈̅ÊÃÕëˆVˆœ˜ÃÊ
that others are out to harm you
UÊ /…œÕ}…ÌÃÊLiˆ˜}Êv>ÃÌiÀʜÀÊϜÜiÀÊ
˜}>}ˆ˜}Êi`ÕV>̈œ˜>Êˆ˜Ã̈ÌṎœ˜ÃÊ leading up to admission often pointed
UÊ iiˆ˜}Ê>ÃÊ̅œÕ}…Ê̅œÕ}…ÌÃÊ>ÀiÊLiˆ˜}Ê
put in your head or disappearing.
Recent research into UK Early
Intervention in Psychosis Services
(EIIP) has shown better prognosis and
yearly savings of up to £290 million by
detecting and treating the symptoms of
*Ê Young people referred from
psychosis early instead of waiting for the
illness to take a firm and permanent hold2.
EIIP works to detect and treat psychosis
early alongside the person and their
Û>Õ>ÌiÊ̅iʈ“«>VÌʜvÊvœVÕÃi`ʅi>Ì…Ê
family. It focuses on broader outcomes
beyond symptom reduction, such as
facilitating the re-integration of a young
person into education, employment and
wider society. EIIP’s fundamental aims
can be summarised as to:
UÊÊ,i`ÕViÊ`ÕÀ>̈œ˜ÊœvÊ՘ÌÀi>Ìi`Ê«ÃÞV…œÃˆÃÊ
(DUP) in order to achieve best
outcomes for individuals and families
accessing EIIP – where possible, prevent
chronic mental illness
UÊÊ
˜}>}iʏœV>ÊVœ““Õ˜ˆÌˆiÃʈ˜Ê years. It aims to prevent rather than reverse
promoting health and reducing stigma
– this will make dialogue about mental
* of people who had received care were
health and psychosis easier and lead to
more people seeking help early
UÊÊ
ÃÈÃÌÊޜ՘}Ê«iœ«iÊ̜ÊÀiV>ˆ“Ê>˜Ê
ordinary life. This may include
efforts to reclaim family life, friends,
education, employment and other
aspirations.
The success of the above depends on
individuals and families being able to
28 | Campaigning to improve mental health among children and young people | www.youngminds.org.uk
access EIIP and mental health services
early. Identified barriers to this include
lack of awareness, shame and stigma3 .
Negative associations with mental
illness can lead a young person and their
family to feel too ashamed to ask for help
from a GP. Additionally, parents report
hesitation due to fear of being blamed
and being labelled as a ‘bad’ parent or
being marginalised alongside the person
experiencing psychosis4 .
EIIP undertook this comparative
study to:
UÊ Ê
materials (at www.sabp.nhs.uk/eiip).
promotion activities on EIIP outcomes
UÊÊ-Ì>˜`>À`ˆÃiÊ̅iÊÜ>ÞÊÜiÊÌÀ>VŽÊ̅iÊ
progress of people who use EIIP during
the three years
UÊ Ê iÊLiÌÌiÀÊ>LiÊ̜ʫÀi`ˆVÌÊÀˆÃŽÊv>V̜ÀÃÊvœÀÊ
poor outcomes.
About the service
EIIP works with young people aged
14–35 with a first episode or at high risk
of developing psychosis for up to three
the effects of serious mental illness. This
framework was founded by Patrick
15
McGorry and colleagues in Australia
in 1989 and has led to increasing global
health reform. The first UK EIIP team was
developed in Birmingham in 2001 and
Surrey And Borders Partnership NHS
Foundation Trust (SABPFT) formed
its first EIIP in 2004. SABPFT now has
three EIIP teams covering East Surrey,
West Surrey and North East Hampshire
The North East Hampshire and
Surrey Heath EIIP team at
a mental health awareness fair
and Surrey Heath.
The World Health
Organisation defines health
promotion as “the process
of enabling people to
increase control over, and
to improve, their health”4 .
EIIP undertook activities
aimed at raising awareness
of psychosis and the help
available. This included:
UÊÊ
by attending local health fairs at
secondary schools, colleges and the
local university;
UÊÊ+Õ>ÀÌiÀÞʓiï˜}ÃÊ܈̅ʏœV>Ê*ÃÊ
and primary care practitioners to raise
awareness of psychosis and EIIP;
UÊ Ê ˜ÛœÛˆ˜}Êޜ՘}Ê«iœ«iÊ܅œÊÕÃiÊ
to co-create a youth orientated EIIP
website with accompanying leaflets,
posters and other promotional
term use of cannabis can increase the
Methodology
The EIIP team keeps a secure database
of all referrals to the service. All
person identifiable data was removed
to make this information anonymous.
Favourable ethical opinion was sought
and granted from the trust’s research and
development department. An audit was
then conducted and data was gathered on
the following:
UÊÊÊ Õ“LiÀʜvÊޜ՘}Ê«iœ«iÊ>VViÃȘ}Ê̅iÊ cost effective illness management7.
EIIP service and their gender
UÊÊ-œÕÀViÃʜvÊÀiviÀÀ>Ê̜Ê
6
UÊ Ê Õ“LiÀʜvÊ̅œÃiÊ>`“ˆÌÌi`Ê̜ʅœÃ«ˆÌ>Ê
in 2009 and 2010
UÊ Ê Õ“LiÀʜvÊޜ՘}Ê«iœ«iÊ`ˆÃV…>À}i`Ê
to primary care (GP) or secondary care
following three years of EIIP.
Results
In 2010, the total caseload of North East
Hampshire and Surrey Heath EIIP was 52.
Of this, 69% of people accessing the
service were male and 31% were female.
This difference in gender is not fully
understood. One hypothesis is that EIIP
efforts have traditionally been focused
on engaging hard to reach groups – such
as young males. While this might have
succeeded, it may have made the service
more male orientated and therefore less
likely to appeal to females. This is an area
yet to be thoroughly investigated.
The majority of referrals were from
local community mental health teams
(CMHTs). These usually originated from
GPs who had referred to CMHTs, who in
turn referred to EIIP. Meetings with GPs
revealed that some were still unaware
that they could refer directly to EIIP.
Some GPs did refer directly to EIIP and
these seemed to be GP surgeries that had
several visits from EIIP clinicians to raise
awareness of the EIIP service.
The third highest source of referrals
was from in-patient wards and self-
referrals. Anecdotal accounts of events
to after three years?
to several weeks of deterioration in
the young person’s mental health.
Professionals and non-professionals
alike sometimes mistakenly dismissed
this deterioration as behavioural
problems or “teenage angst”.
substance misuse services reported using
a range of substances including cannabis.
There is evidence to show that long-
risk of psychosis and that young people
experiencing psychosis may turn to
cannabis as a means of self-medicating6 .
EIIP achieved a 75% reduction in
admissions to acute in-patient units and
50% reduction in admissions under
Mental Health Act (1983) sectioning
(formal admissions) powers. There
is clear evidence from peer reviewed
studies that shows less use of emergency
and in-patient services results in more
Following three years of EIIP, 65%
discharged back to their GPs. This
was following a tailored and phased
approach to offering interventions
according to individual needs. The process
of discharging to GPs is prepared for well
in advance (no less than six months
before discharge) so that the individual
and their family is prepared for less
intensive input.
Conclusions
While the results are promising, further
investigation is needed to determine if
health promotion can lead to sustained
improvements in health outcomes for
young people experiencing psychosis
who access EIIP. Further work is
required to equalise access to EIIP
regardless of demographics, increase
self-referrals by young people, their
families and GPs. This is likely to
reduce DUP and improve the long-
term prospects for those who have
experienced first episode psychosis. !
References
1. Department of Health (2011) Mental health
promotion and mental illness prevention:
The economic case, London, UK.
2. Jones, P., Shiers, D., Smith, J. (2010)
Early Intervention in Psychosis: Why a
specialised EIIP service model is preferable
to a CMHT model. http://bit.ly/dPuOVA.
Source of referrals 2010
4% 2%
4%
10%
10%
15% 55%
Community Mental Health Teams
GP
Self Referral
In-patient Ward
Education
Substance Misuse Services
Criminal Justice System
Hospital admissions
20
10
5 2
0 0
2009 2010
YOUNGMINDS MAGAZINE | Issue 112 June / July 2011 | 29
KNOWLEDGE
3. Wong, C., Davidson, L., Anglin, D., Link,
B., Gerson, R., Malaspina, D., McGlashan,
T., Corcoran, C. (2009) Stigma in
families of individuals in early stages
of psychotic illness: family stigma and
early psychosis. Early Intervention in
Psychiatry 3(2): 108-115.
4. WHO (2009) Milestones in Health
Promotion: Statements from Global
Conferences. http://bit.ly/e0IBID
5. Henquet, C. (2005) Prospective cohort
study of cannabis use, predisposition for
psychosis and psychotic symptoms in young
people. British Medical Journal, 330, 11-14.
6. McCrone P., Park A-L., & Knapp M. (2010)
Economic Evaluation of Early Intervention
(EI) Services: Phase IV Report. Personal
Social Services Research Unit (PSSRU)
Discussion Paper 2745.
Sarah Amani is the team manager for North
East Hants and Surrey Heath EIIP team
Where does EIIP discharge
35%
65%
Community Mental Health Team
GP
Formal admissions to hospital
8
4
2009 2010