YOUNGMINDS MAGAZINE | Issue 112 June / July 2011 | 2928 | Campaigning to improve mental health among children and young people | www.youngminds.org.uk

KNOWLEDGE KNOWLEDGE

Where does EIIP discharge to after three years?

Hospital admissions

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

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:

other people do not

everything is about or related to you

that others are out to harm you

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 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 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:

(DUP) in order to achieve best outcomes for individuals and families accessing EIIP – where possible, prevent chronic mental illness

promoting health and reducing stigma – this will make dialogue about mental health and psychosis easier and lead to more people seeking help early

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

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:

promotion activities on EIIP outcomes

progress of people who use EIIP during the three years

poor outcomes.

About the serviceEIIP works with young people aged 14–35 with a first episode or at high risk of developing psychosis for up to three years. It aims to prevent rather than reverse the effects of serious mental illness. This framework was founded by Patrick 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

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:

by attending local health fairs at secondary schools, colleges and the local university;

and primary care practitioners to raise awareness of psychosis and EIIP;

to co-create a youth orientated EIIP website with accompanying leaflets, posters and other promotional materials (at www.sabp.nhs.uk/eiip).

MethodologyThe 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:

EIIP service and their gender

in 2009 and 2010

to primary care (GP) or secondary care following three years of EIIP.

ResultsIn 2010, the total caseload of North East Hampshire and Surrey Heath EIIP was 52.

ConclusionsWhile 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.

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 leading up to admission often pointed 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”.

Young people referred from substance misuse services reported using a range of substances including cannabis. There is evidence to show that long-term use of cannabis can increase the 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 cost effective illness management7.

Following three years of EIIP, 65% of people who had received care were 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.

0

5

10

15

20

0

2

4

6

8

Formal admissions to hospital

2009 20092010 2010

Community Mental Health Teams Community Mental Health Team

GP GP

Self Referral

In-patient Ward

Substance Misuse ServicesEducation

Criminal Justice System

Source of referrals 2010

4%

4%

10%

10%

15%

2%

55% 65%

35%

The North East Hampshire and Surrey Heath EIIP team at a mental health awareness fair