Specialist services
The current specialist service baseline
The evidence for early intervention in psychosis is overwhelming prompting the development of Early Intervention Services (EIS) as a political imperative in England and many countries internationally. By March 2006 about half the population of England could access EIS, (Tiffin & Glover, 2007) and with continued growth in new services subsequently. However access to EIS across the UK still varies by country and by region. Where clients can only access standard community mental health teams then the reality of what these young people receive can still be characterised as ‘too little and too late’:
- Typically these individuals with a FEP experience delays in recognition and treatment of 1-2 years (Johannessen, 2004) by which time the level of illness may well be severe and the engagement driven by risk and problematic.
- Excessive delay is a significant contributor to poor response to treatment, recovery and long term outcome (Marshall, Lewis, Lockwood, et al, 2004).
- Most are hospitalised initially, in crisis, commonly with traumatic police involvement and use of the mental health act, lengthy hospital stays and coercive inpatient practices (Yung, Organ, Harris, et al, 2003).
- Clients and carers too frequently complain about lack of practical help and education about psychosis, whilst clinical attention focuses on treatment issues neglecting personal adaptation, functional recovery, relapse prevention and carer needs.
- Unsurprisingly, given the coercive early experiences and stigma, 50% of these young people are ‘lost’ to follow up within 12m, often to re-emerge in crisis in a relapse.
- More than half will relapse by 18 months (Craig, Garety, Power, et al, 2004). And with each relapse, the speed and quality of remission are progressively impaired, whilst the risk of further relapse and persisting symptoms increases (Wiersma, Nienhuis, Sloof & Giel, 1998).
- By 5 years, the majority (55%) of patients will be unable to achieve remission from their episodes of psychosis (Robinson, Woerner, Alvir, et al, 1999) and most of the suicides will have occurred (Mortensen & Juel, 1993).
When even good quality “standard” mental health services are compared with Early Intervention Services (EIS), the latter report shorter durations of untreated psychosis, lower use of legal detention, reduced hospital admissions (Yung, Organ & Harris, 2003), lower relapse rates, (Craig, Garety, Power, et al, 2004) better recovery, better service engagement and client/carer satisfaction and lower suicide rates (Power, 2004). Furthermore the economic impact of EI services modelled over 1 and 3 year periods (McCrone, Dhanasiri & Knapp, 2007) reveal the potential for significant savings when compared to standard care
- EI would save £16K per patient over 1 year and £46K over 3 years
- The saving is largely insensitive to changes in the cost of the actual EI team
- The savings are mainly due to lower readmission rates for EIS