The Early Intervention in Psychosis Team (EIIP)

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