This guidance is intended to provide support to local commissioners and providers in implementing the access and waiting time standard for early intervention in psychosis (EIP) services.
It has been coproduced by a wide range of experts, including people with lived experience of services, to set out what works and provide a blueprint for localities to follow. It is not intended to direct but to support, by demonstrating the evidence and setting out clearly how progress will be measured.
Key messages include:
- Psychosis is characterised by hallucinations, delusions and a disturbed relationship with reality, and can cause considerable distress and disability for the person and their family or carers. A diagnosis of schizophrenia, bipolar disorder, psychotic depression or other less common psychotic disorder will usually be made, although it can take months or even years for a final diagnosis.
- Treatment can begin as soon as a provisional diagnosis of rst episode psychosis is made – it does not have to wait for a final diagnosis. Treatment should be provided by an early intervention in psychosis (EIP) service. These services are evidence-based, cost-saving and preferred by service users and carers over generic services.
- People who experience psychosis can and do recover. The time from onset of psychosis to the provision of evidence-based treatment has a signi cant influence on long-term outcomes. The sooner treatment is started the better the outcome and the lower the overall cost of care.
- To improve access to EIP services, NHS England is introducing an access and waiting time standard. It is for all people experiencing first episode psychosis (including that associated with trauma or substance misuse). The standard is also relevant for people at high risk of psychosis (an ‘at risk mental state’).
- The standard requires that, from 1 April 2016, more than 50% of people experiencing first episode psychosis commence a National Institute for Health and Care Excellence (NICE)- recommended package of care within two weeks of referral. Treatment will be deemed to have commenced when the person:
- has had an initial assessment; AND
- has been accepted on to the caseload of an EIP service capable of providing a full package of NICE-recommended care; AND
- has been allocated to and engaged with by an EIP care coordinator.
- All NHS-commissioned EIP services will be expected routinely to record data regarding EIP waiting times, NICE-recommended interventions and outcome measures via the Mental Health Services Data Set. They will also be expected to take part in a national quality assessment and improvement programme.
- EIP services should provide the full range of psychological, psychosocial, pharmacological and other interventions shown to be effective in NICE guidelines and quality standards, including support for families and carers. Effective and integrated approaches are needed to address the social and wider needs of people with psychosis to help them live full, hopeful and productive lives. EIP services also need the capacity to triage, assess and treat people with an at risk mental state, as well as to help those not triaged to access appropriate treatment and support.
- Commissioning EIP services should be underpinned by estimated local incidence of psychosis, derived to incorporate a range of demographic features such as ethnicity, age, population density and deprivation to ensure services are designed to serve fully the needs of a particular locality.
- Commissioners and providers shouldensure that children and young people (aged under 18) also benefit fully from the standard and that there are robust local arrangements in place between children and young people’s mental health services and EIP services so that specialist expertise in working with children and young people with psychosis is available.
- Health Education England will shortly make available a workforce planning tool to support commissioners and providers to plan the EIP capacity and skill mix required locally to ensure sustainable delivery of high-quality, NICE-recommended care.