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Rethink Mental Illness. Lost Generation 1

Lost Generation

Why young people with psychosis are being left behind, and what needs to change.

2 Rethink Mental Illness. Lost Generation

Who we are

Rethink Mental Illnessisacharitythatbelievesabetterlifeispossibleforpeopleaffectedbymentalillness.Formorethan40yearswehavebroughtpeopletogethertosupporteachother.Werunservicesandsupportgroupsthatchangepeople’slivesandwechallengeattitudesaboutmentalillness.

The IRIS Network isagroupofmentalhealthexpertsandprofessionalswhosupportthepromotionofEarlyInterventioninPsychosis(EIP).FirstformedtosupporttheNationalEarlyInterventionProgramme(2004-2010),thisnetworkbringstogetherelectedEarlyInterventionregionalleadstoshareissuesandsolutions.

Contents

Summary 1

Foreword 2

Psychosis and young people 3

Facts and stats about Early Intervention in Psychosis services 4

Why Early Intervention in Psychosis is so important 6

Tackling inequality for mental health 9

Early intervention under threat 10

Recommendations 14

Call to Action 15

Protecting young people: what politicians need to do now 16

References 17


Summary

EarlyInterventioninPsychosis(EIP)serviceshelpyoungpeopleaged14-35torecoverfromafirstepisodeofpsychosis,andtogainagoodqualityoflife.Theysupportmorethan10,000youngpeopleeachyear.

EIPcaresignificantlyimprovesayoungperson’sprospectsofrecoveringfrompsychosis.Italsoreducesthelikelihoodthattheywillrelapse,orbedetainedundertheMentalHealthAct,potentiallysavingtheNHS£44millioneachyearthroughreduceduseofhospitalbeds.1Earlyinterventionalsoreducestheriskofayoungpersontakingtheirownlife,fromupto15%to1%.2

However,manyEIPservicesarestrugglingtomaintainhighlevelsofcare,andarefacinganuncertainfuture,becauseofcutstofunding.Whereservicesdoexist,manyyoungpeoplearefacingunacceptabledelaysinaccessingcare.Thisseriouslyaffectstheirchancesofrecovery,andincreasesthelikelihoodofthemdevelopingalifelongillness.

Asaresult,weareatriskoflosingagenerationofyoungpeoplewhoserecoveryfrommentalillnessisbeingjeopardised–tensofthousandsofyoungpeoplewho,withtherightsupport,mightotherwisehavegoodqualityoflifeandplayameaningfulroleinsociety.

Thisreportpresentsnewevidencefromthefrontlineabouttheextentofcutstoresourcingandbudgets,andthenegativeimpactonEIPservicesandtheyoungpeopletheysupport.

What we found:

• 50%ofEIPservicessaytheirbudgethasdecreasedinthepastyear,somebyasmuchas20%.

• 58%ofEIPserviceshaveloststaffoverthelast12months.

• 53%saythequalityoftheirservicehasdecreasedinthepastyear.

• ManyyoungpeoplefaceunacceptabledelaysinaccessingEIPservices,greatlyreducingtheirchancesofrecovery.

What we recommend:

• YoungpeopleexperiencingpsychosisneedguaranteedaccesstoEIPsupport.TheGovernmentmustintroduceamaximumwaitingtimeof28daysforaccessingEIPservicesfromthepointofreferral.

• NHSEnglandmustmakeprovisionofEIPservicesakeypriorityforcommissioners.Toachievethis,itshoulddesignCQUINs3andotherincentivestoensurelocalcommissionersrewardgoodqualityEIPservices.

• ClinicalcommissioninggroupsmustensurethattheycommissionthefullEIPmodel,4

includingspecialistemploymentandphysicalhealthcaresupport.


Foreword

Itisnearly13yearssinceEarlyInterventioninPsychosis(EIP)serviceswerewidelyintroducedacrosstheUK.InthattimeEIPhasbecomeestablishedasoneofthemosteffective,popularandinnovativeservicemodelsinmentalhealth.

FewservicescanmatchEIPforclinicalandeconomicoutcomes.Thereisawealthofevidencewhichshowsthatearlyinterventionsignificantlyimprovespeople’sprospectsofrecovery,andreducesthelikelihoodofthemrelapsingortakingtheirownlife.

EarlyinterventionalsooffersvaluablelongtermsavingstotheNHSbyreducingthedependenceonothermentalhealthservices.PeoplewhohaveEIPsupportaremorethan20%lesslikelytobelegallydetainedinhospitalundertheMentalHealthActinthefirsttwomonthsoftheirillness.5

Buttherealityisthatwithoutadequatefunding,EIPservicescannotcontinuetoofferthewide-rangingsupportforyoungpeoplethattheyaspireto.ItisthereforedeeplyworryingthatmanyEIPteamssaytheyarestrugglingtomaintainhighstandardsofcareinthefaceofsignificantcutstoresources.

InthisnewsurveyofEIPservicesinEngland,carriedoutbytheIRISNetworkandRethinkMentalIllness,50%ofservicessaidtheirbudgethasbeencutinthepastyear,sometimesbyasmuchas20%.Morethanhalfsaidthatthequalityoftheircarehasdecreasedinlinewithcutstofunding.

EIPservicesarealsolosingstaff,andhavingtoreducethenumberoftreatmentsandsupporttheycanofferpeople.Evenworse,someEIPservicesarebeingdisbandedentirelyorabsorbedintocommunitymentalhealthteams.

Theresultisthataftermorethanadecadeofprogressandsuccess,EIPcareiseffectivelydisappearinginsomeareasofthecountry.

Andwhilesomeservicesaremanagingtomaintainstrongoutcomesdespitereducedbudgets,theoverallpictureisoneofprofoundconcernanduncertaintyaboutthefutureforpeopleexperiencingpsychosis.EIPservicesareatatippingpoint,andfurthercutswillseriouslythreatentheircapacitytosupportsomeofthemostvulnerableyoungpeopleinoursociety.Weareatriskoflosingageneration.

TheGovernmenthasmadeacommitmenttoputmentalhealthonaparwithphysicalhealthintheNHS,butthatisfarfromarealityasthingsstand.EnsuringthatEIPserviceshavethefundingtheyneedwouldbeoneobvioussteptowardsachievingthat.

TheGovernment,theNHSandcommissionersmustmakeEIPservicesapriorityatanationalandlocallevel.Wearecallingonthemtoactnow,orriskwritingoffthefuturewellbeingoftensofthousandsofyoungpeopleacrossthecountry.

Professor Max BirchwoodCo-founder,IRISNetworkProfessorofYouthMentalHealth,UniversityofWarwick

“ After more than a decade of progress and success, EIP care is effectively disappearing in some areas of the country”


Psychosis and young people

Psychosisisamedicaltermusedtodescribehearingorseeingthingsthatarenotthere,orholdingdelusionalbeliefs.Commonexamplesincludehearingvoicesorbelievingthatpeoplearetryingtodoyouharm.Itcanbeexperiencedasaone-offepisode,butifleftuntreatedcanleadtolongtermillnessanddisability.

Around1in100peoplewilldevelopafullpsychoticepisodeintheirlifetime.Thevastmajority(8outof10)willexperiencetheirfirstepisodebetweentheagesof15and30.6

Psychosiscanhaveanextremelydamagingimpactonayoungperson’swellbeingandqualityoflife.Itcanaffecttheirrelationshipswithfriendsandfamily,andtheirabilitytoengageineducation,trainingandemployment.Italsomakesitverydifficulttomanageeverydaytasks,likepayingbillsorrent.

Thisleavesyoungpeoplevulnerabletodevelopingaseriousmentalhealthcrisis,beingdetainedinhospitalundertheMentalHealthAct,orgettingcaughtupinthecriminaljusticesystem.

Earlyinterventionmakesamassivedifferenceinhelpingyoungpeoplerecoverfromafirstepisodeofpsychosis.WhensomeonereceivesEarlyInterventionsupportwithintwomonths,theirprospectsofrecoveryaresignificantlyimproved,butadelayoflongerthansixmonthsgreatlyreducestheirchances.7

Similarly,whenayoungpersonreceivesEarlyInterventionsupportinthefirst14monthsoftheirillness,theyaremuchmorelikelytomakeafulllongtermrecovery.8



FACTS AND STATS ABOUT EIP SERVICES 50% OF EIP SERVICEShave been cut in the past year

35% OF PEOPLE

MORE THAN 10,000young people get EIP care each year

12% OF PEOPLE compared to

under EIP care are in employment

in standard mental health care


FACTS AND STATS ABOUT EIP SERVICES

£44 MILLION EACH YEAR

FROM 44%

If everyone who was eligible received early intervention, it would save the NHS

EIP support reduces the probability of someone being ‘sectioned’

EIP support reduces the risk of a young person taking their own life

in the first two months of psychosis

FROM UP TO 15% TO 1%

TO 23%


Why Early Intervention in Psychosis is so important

EarlyInterventioninPsychosis(EIP)teamsarethebestmodelforofferingearlyinterventiontoyoungpeoplewithpsychosis.Theytakeaholisticapproachtosupportingpeopleagedbetween14and35torecoverfromafirstepisodeofpsychosis.Thatincludesofferingsupportfromawiderangeofhealthprofessionals,includingpsychiatrists,psychologists,communitymentalhealthnurses,socialworkersandsupportworkers.9Thisgivesyoungpeopleabetterchanceofexperiencingagoodqualityoflife.



Interventionsaremosteffectivewhenprovidedbyaspecialistteam.Theyoftenincludefamilytherapy,supportwithmaintainingemploymentandeducation,adviceonmanagingphysicalhealthcareandhelpwithdevelopingsupportnetworkswithfamilyandfriends.PeoplenormallyreceiveEIPcareforaminimumofthreeyears,andamaximumoffiveyears.

Evidence shows that EIP services help people recover and offer the NHS significant savings, in the following ways:

Reducing demand on other services

PeoplewhohaveEIPsupportarelesslikelytoneedothermentalhealthservices,suchasexpensivehospitalcare,whichresultsinsignificantsavingsfortheNHS.ItalsoreducestheprobabilityofsomeonebeingdetainedinhospitalundertheMentalHealthActfrom44%to23%inthefirsttwomonthsofpsychosis.14NHSEnglandhasacknowledgedthatcutstoEarlyInterventionservicesareincreasingdemandforbedsonmentalhealthwardsforyoungpeople.15

Byreducingdependenceonhospitalbeds,EIPcaresavestheNHSanestimated£5,536perpersoninthefirstyearofpsychosis,and£15,862duringthefirstthreeyears.16Ifearlyinterventionwasavailabletoeveryonewhocouldbenefitfromit,theNHSwouldsave£44millioneachyearthroughreduceduseofhospitalbeds.17

Better physical health

Youngpeoplebeingtreatedforpsychosisarevulnerabletodevelopingsideeffectsfromantipsychoticmedication,includingrapidweightgainandchangestometabolism.Overtime,thesecanleadtoconditionslikediabetes,heartdiseaseandcancer,whichputsyoungpeopleatsignificantriskofdying15-20yearsyoungerthanthegeneralpopulation.12

EIPteamsofferyoungpeoplesupportwithmanagingtheirphysicalhealthwhichisrarelyavailabletothemfromtheirGPorothermentalhealthservices.ThisisrecognisedintheinternationalHealthyActiveLives(HeAL)consensusstatement.13

Reduced suicide and homicide rates

EIPsupportreducestheriskofayoungpersonwithpsychosistakingtheirownlife,fromupto15%(theriskofsuicideforpeoplewithpsychosis),tojust1%.10

Theriskofsomeonewithuntreatedpsychosiscommittinghomicideisverysmall(around0.17%).However,earlyinterventionreducesthatto0.011%.11

Improved employment and education prospects

TheemploymentrateforyoungpeopleunderEIPcareis35%,comparedtojust12%forpeopleinstandardmentalhealthcare.18

Thisleadstoincreasedannualearningsof£4,299perperson,comparedtopeopleusingothermentalhealthservices.19Theestimatedcostoflostemploymentisaround£2,000lowerforeachpersonunderEIPcareperyear.20

Better experiences of care

YoungpeopleusingEIPservices21saythattheyhavemorepositiveexperiencesofEIPcarethanofothermentalhealthservices.YoungpeoplesaidEIPsupporthelpedthemgainapositivesenseofself-identity,anddevelopstrongfamilyrelationships(whichinturnmeansfamilymembersaremoreengagedinthecarethatayoungpersonreceives).

TheyalsowelcomedtheflexibilityofEIPsupport,especiallyinrelationtothelengthoftimethatitisavailabletothem.


Evidence from the front line

“We offer people support that they would not otherwise get”

“I felt valued as a person”

Iwasalsoencouragedtovolunteerinthecaféinmylocalmentalhealthcentre.Sincethen,I’vealsojoinedtheboardoftrusteesatthecentre,whichhasgivenmealotofprideandself-esteem.

Withoutearlyintervention,Iwouldhavebecomealotmoreisolatedandreclusive,andwouldhavehadlessinsightintomycondition.SoonIamgoingtobedischargedcompletelyfrommentalhealthservices,whichshowshowmuchofadifferenceearlyinterventionmadeforme.”

Paul* is an EIP service lead. He and his colleagues have fought hard to protect his service from cuts by demonstrating the strength of their outcomes.

“Toprotectourservicefromallthefinancialuncertaintieswe’refacing,we’rereallyproactiveandpositiveaboutmakingthecaseforourservicetoseniormanagementinourTrust.

Wecollectevidenceoneverythingfrompatientsatisfaction,tothenumberofpeoplewe’vebeenabletodischargebackintoprimarycarebecausetheynolongerrequireoursupport–that’scurrentlyaround75%ofthepeopleweworkwith.

Wealsoofferadditionalservicestoourclientswhichtheyotherwisemightnotreceive.Forexample,wehaveastrategyforsupportingpeoplewiththeirphysicalhealth,includingofferingadviceonhealthyliving,andtakingbloodsamples.

It’sthatwillingnesstotakeextrastepsandtoinnovatethatmakesEIPservicessoattractive,andthat’swhatwe’vetriedtoshoutabout.Ithinkwe’reabletodothatbecausethepeoplewhoworkforEIPservicesarereallypassionateandpersonallyinvestedinwhattheydo.Wehaveacleartangiblegoalofhelpingyoungpeopletorecover,whichperhapsisn’tthesameforservicesthathelpchronicallyillpeople.

Weknowwe’llhavetocontinuetoshoutabouthowimportantourworkis,ifwe’regoingtobeabletokeepofferingthelevelofsupportwecurrentlydo”.

Denny Reader (32), from Warwickshire, developed psychosis as a teenager. He says that the support he received from his Early Intervention service was crucial in helping him recover.

“Ihadbeenillfortwoyears,andwassectionedtwice,beforebeingreferredtotheEarlyInterventionteamwhenIwas23.Thestaffwereincrediblypositiveandrespectful,andIfeltreallyvaluedasaperson.

ItwasmuchmoreofaholisticapproachthanprevioussupportI’dreceived.Theytalkedtomeaboutmyphysicalhealth,aswellmymentalhealth,andmadesureIwaslookingaftermyself.

Iwasreferredtoapsychologist,whohelpedmetobecomemoreawareofmyowncondition.AsIgainedmoreinsightintomyillness,IfeltIwasmoreincontrolofit,whichplayedabigpartinhelpingmerecover.Iwasalsogivenafantasticsocialworker,whoreallylistenedtome,andwestruckupaverystrongrelationship.Hehelpedmetogetinvolvedinsocialgroups,includingabowlinggroup,whichenabledmetomeetotherpeopleandfeellessisolated.

*Nothisrealname.8 Rethink Mental Illness. Lost Generation


Tackling inequality for mental health

ThevalueandbenefitsofEarlyInterventioninPsychosis(EIP)servicesareevenmoreimportantinthecontextoftheGovernment’scommitmenttoachieving‘parityofesteem’formentalhealthwithintheNHS.Thatmeansgivingpeoplewithmentalillnessequalpriorityandqualityofcaretopeoplewithphysicalillness.

Butthisisfarfromarealityforpeoplewithpsychosis.ManypeoplemissoutoncrucialtreatmentsrecommendedbytheNationalInstituteforHealthandCareExcellence(NICE).Asaresult,peoplewithpsychosisoftenfaceappallinghealthproblemsandpoorqualityoflife.

• Peoplewithpsychosisandotherseverementalillnessesdieonaverage15-20yearsyoungerthanthegeneralpopulation,mainlyfrompreventablephysicalhealthproblems.22

• Therearenomandatorywaitingtimesforaccesstospecialistmentalhealthservices,asthereareinphysicalhealthcare.23

• Fewerthan30%ofpeoplewithschizophreniareceiverecommendedphysicalhealthchecks.24

• Only8%ofpeoplewithpsychosisandschizophreniaareinemployment.25

• Fewerthan50%ofpeoplewithschizophreniaareofferedrecommendedtalkingtherapies.26

• WhileNHSfundingremainsstableacrosstheboard,mentalhealthtrustsinEnglandhavehadtheirfundingcutbymorethan2%inrealtermsoverthepasttwoyears.27

Inthecontextofthesehealthinequalities,thevalueoftheholisticsupportofferedbyEIPservicesisevenmoreclear.Thesupporttheyofferintermsofphysicalhealth,talkingtherapies,andemploymentsupport,arerarelyavailabletoyoungpeoplewithpsychosisanywhereelseinthehealthsystem.

ThiswasrecognisedbytheSchizophreniaCommissionin2012,whichrecommendedEIPservicesasoneofthemosteffectivemodelsforsupportingpeoplewithpsychosis,andsaidthattheholisticethosofEIPservicesshouldunderpinallmentalhealthservicesforpeopleaffectedbypsychosis.28

EIPservicesshouldbeviewedbylocalandnationaldecision-makersasasolutiontosomeoftheproblemscausedbyinequalitiesintheNHS,andanimportantsteptowardsachieving‘parityofesteem’.

“Early Intervention in Psychosis has been the most positive development in mental health services since the beginning of community care”

TheSchizophreniaCommission2012


Early intervention under threat

FromDecember2013–January2014,RethinkMentalIllnessandtheIRISNetworkconductedacomprehensivesurveyofEarlyInterventioninPsychosis(EIP)servicesacrossEnglandtoinvestigatehoweconomicandpoliticalpressuresareimpactingonthem.29Morethan75%ofEIPservicesandteamscompletedthesurvey.

What we found

We asked:

• Comparedwiththelastfinancialyear,howhasyouroverallservicebudgetchanged?

• Howdoyoufeeltheabovechanges(andanyotherrelevantfactors)haveaffectedthequalityoftheEIPservice?

• Hastheskillmixinyourteamchanged?Forexample:newposts,increasedstafftraining,downgradingofposts,lossofcertainposts.

Budgets are being squeezed in half of all EIP services

50% of services say their budget has decreased in the past year.

17% say their budget has been reduced by 6-10%.

11% say they have faced cuts of 11-20% in the last year.

50% of services say their budget has not changed in the last year.

No services say that their budget has increased in the last year.


Quality of EIP services is being adversely affected

53% of services say the quality of their service has decreased in the past year.

32% say their quality has not changed in the last year.

16% say their quality has improved in the last year.

Staff posts are being lost or downgraded

58% of services say they have lost staff in the past year.

18% report no changes to staff levels in the last year.

10% report an increase in staffing in the last year.

10% 20% 30% 40% 50% 60% 70% 80% 90% 100%0%


Uncertainty impacting on staff morale

Anumberofservicesraiseconcernsaboutwiderchangestakingplacewithintheirmentalhealthtrust.Someserviceshavejustbeenthroughreconfigurations,andarestillunsureabouthowthatcouldimpactwhattheydoonalongtermbasis.OtherservicesareanxiousaboutwhatthenextroundofcommissioningdecisionswillbringinApril2014.

Generally,thereisagreatdealofuncertaintyamongservicesaboutthefuture,despitetheexcellentoutcomesthatEIPservicesachieve.Thisisstartingtoaffectstaffmorale,whichinturnimpactsonthecaregiventoyoungpeoplewithpsychosis.

What are the implications for EIP services, and the young people they support?

Loss of crucial specialist support and expertise

Morethanhalfofservicessaytheyhaveloststaff,orhadtodowngradestaffposts,whileothersreportthattheskillsmixwithintheteamhaschanged.Insomecasesservicessaytheyhavelostspecialiststaffsuchasvocationalsupportworkers,orhadtoreplacethemwithstaffwholackexpertise.

Otherserviceswereunabletoreplacevacantpostsduetolackoffunding.Thismeansthatyoungpeoplearemissingoutontheunique,holisticsupportwhichmakesEIPmoreeffectiveintreatingpsychosisthanothercommunitymentalhealthservices.

Servicessaythattheyhavelessscopetoofferoutreachsupport,suchasworkingwithlocalschoolsorprimaryservicestoincreaseawarenessofpsychosisandhowitcanbetreated.Someservicesalsosaythattheyhavehadtoreducethefamilysupporttheyoffer.Thismeansthatcarersarelessabletoplayanactiveroleinthetreatmentthatyoungpeoplereceive,andaregivenlessinformationabouttheircondition.

Delays in accessing EIP care

Highercaseloadsandreducedlevelsofstaffareresultinginmanyyoungpeoplehavingtowaitevenlongertoaccessservices.Thisdamagestheirprospectsofrecoveringfromafirstepisodeofpsychosis,andincreasesthelikelihoodthattheywillbehospitalisedordetainedundertheMentalHealthAct.

Italsoreducestheirchancesofmakingasuccessfullongtermrecoveryfrommentalillness,andbeingabletoplayameaningfulroleinsociety.

Reduced range of interventions offered

OneofthestrengthsoftheEIPmodelistherangeofinterventionsandservicestheyoffertoyoungpeople.Servicesreportincreasingconcernsathavingtoreducetheavailablerangeofinterventionsduetostafflossesandincreasingtimepressures.Thismeansthatyoungpeoplewithpsychosisarelesslikelytogetsupportwiththeirphysicalhealth,employmentandtraining,andsocialskills.

Higher than recommended caseloads

Oursurveydidnotexplicitlyaskaboutcaseloads,buttellingly,nearlyathirdofteams(31%)reportthattheircaseloadshaverisenabovetherecommendedlevel.Servicessaythisisduetostafflosses,pressuretomeettargets,anddifficultiesindischargingpeopletoothermentalhealthteams.

TheresultisthatyoungpeoplearegettinglesstimeandsupportfromEIPprofessionals.ItalsomeansthatEIPteamsareforcedtodischargeyoungpeopletolesseffectivementalhealthservicesorprimarycare,beforetheyhavecompletedtherecommendedthreeyearsofsupport.


“Vulnerable young people are being left to fend for themselves”

John* is a community mental health nurse in the north east of England.

“Weusedtohavealarge,standaloneEIPserviceinourarea,madeupofseveralteamsandaround40dedicatedclinicalstaff.

Butthatallchangedtwoyearsago.OurTrusthadtocutcommunitymentalhealthprovisionbyover10%,soitmergedtheEIPteamswiththeCommunityMentalHealthTeams(CMHTs).

Asaresult,earlyinterventionhaseffectivelydisappearedinourarea.Forastart,wenowhavemuchlesscapacitytoidentifyandtakeonyoungpeoplewhocouldbenefitfromoursupport.Weusedtoidentifyaround100youngpeopleeachyear,butnowthat’sdownto50.Itmeansthatalotofvulnerableyoungpeoplearebeinglefttofendforthemselves.

Everyonehasmuchbiggercaseloadsnow.Weeachusedtosupportaround15peopleatatimeattheEIPservice,butnowitcanbeanythingupto45people.Asaresult,wecan’tgiveyoungpeoplethetimeorspecialistsupporttheyreallyneed.

Oneofthebiggestlosseshasbeenthesocialandhealthsupportweusedtooffer,likegettingpeopleinvolvedinrunninggroups,goingtothegym,socialeventsandplayingfootball.Allthat’scompletelygone,becausewejustdon’thavethetime,resourcesorstafftokeepitgoing.

Itfeelslikewe’renowbackatthesameplaceweweretenyearsago,beforetheEIPservicewasfirstintroduced.ThestafffromtheEIPservicehavebeenleftcompletelydemoralised,andmanyhavedecidedtoleave.Theynolongerfeeltheycanmakeameaningfulcontributiontosupportingyoungpeoplewithpsychosis.”

Evidence from the front line

*Nothisrealname. Rethink Mental Illness. Lost Generation 13


Recommendations

ThisreportshowsthatEarlyInterventioninPsychosis(EIP)servicesarestrugglingtomaintainqualitysupportforyoungpeoplewithpsychosis,inthefaceoffundingcutsandincreasinguncertaintyaboutthefuture.

EIPisnotaluxuryservice,andfurthercutstofundingwillleavetensofthousandsofyoungpeoplewithoutthesupporttheyneedtorecoverandgainagoodqualityoflife.ItwillresultinmoreyoungpeoplegoingintocrisisorbeingdetainedundertheMentalHealthAct,andwillplaceNHSservicesunderevengreaterstrain.NHSEnglandhasacknowledgedthatcutstoEarlyInterventionservicesareincreasingdemandforbedsonmentalhealthwardsforyoungpeople.30

ButdespitetheexcellentclinicalandeconomicoutcomesthatEIPservicesoffer,theyarecurrentlyoverlookedintheNHS’squalityindicatorframeworks.Thismeansthatnationalandlocaldecision-makerscannotbeheldtoaccountforwhetherornotyoungpeopleacrossthecountryareabletoaccessEIPcare.Wethinkthisisunacceptable,andweknowwhatneedstobedone.



Thehuman,socialandeconomiccostsoffailingtoprotectEarlyInterventionservicesaretoogreattoallowthattohappen.RethinkMentalIllnessandtheIRISNetworkarecallingontheGovernment,NHSEnglandandcommissionerstoensurethatyoungpeoplewithpsychosisgetthesupporttheyneedbyimplementingthefollowingrecommendations:

Call to action

1.

2.

3.

4.

5.

6.

7.

8.

Clinical Commissioning Groups(CCGs) mustcommissionEIPservicesthatofferspecialistemploymentandphysicalhealthsupport.Theyshouldensurethatservicesmeetlocaldemand,byusingavailabledatawhichpredictstheprevalenceoffirstepisodepsychosisintheirarea.31

The Government mustintroduceamaximumwaitingtimeof28daysforaccessingEIPservicesfromthepointofreferral,ensuringthatyoungpeoplereceiveEIPcareasearlyintheirillnessaspossible.

NHS England mustdesignCQUINsandotherfinancialincentivestoensurelocalcommissionersprioritiseandrewardgoodqualityEIPservices.

The Government mustcollectdataabouthowlongpeoplewaitbeforereceivingEIPcare,aspartoftheNationalMentalHealthMinimumDataSet.32

NHS England shouldcarryoutanannualauditofEIPservicestocheckhowratesofaccesscomparetooveralldemands,andtomonitordelaysinaccessingcare.ItshouldalsomeasurewhetherEIPservicesreflectbestpracticeasoutlinedintheIRISNetworkguidelines.33

The Government shouldincludemeasuresrelatingtoEIP(suchasspeedofaccesstoEIPcare)inthevariousqualityindicatorframeworksfortheNHS.

CCGsshoulddesignlocalcarepathwaysthroughconsultationwithyoungpeoplewithlivedexperienceofpsychosis,carersandfamilies.

NHS England shouldmakeitmandatoryformentalhealthproviderorganisationstocollectdataontheamountoftimepeoplewaitbeforereceivingtreatmentforafirstepisodeofpsychosis,delaysinaccessingEIPandratesofaccesstoservices.Thisdatashouldthenbeincorporatedintothevariousoutcomesframeworks.34


Protecting young people: what politicians need to do now

Thisreportshowsthattherealityforyoungpeoplewithpsychosiscontrastsstarklywithwhatpoliticianssayshouldbehappening.Thevalueandimportanceofearlyinterventionforyoungpeopleisrecognisedinanumberofkeystrategiesandpolicies.Buttheywillhavelittleornoimpactunlessnationalandlocaldecision-makerstakeactiontomakethemareality.

Inthecurrenteconomicclimate,itismoreimportantthaneverthathealthservicesmaximisetheirresourcesandreducecosts,whileimprovingpeople’scareandcreatinglastingpositiveoutcomes.Atanationallevel,weareseeingadeliberateshifttowardevidence-basedpolicyandpractice.Thatiswhyitissobafflingthatserviceswhichhavesuchimpressiveoutcomes,andoffersuchsignificantsavings,arefacingmajorfundingcuts.

Nationalandlocaldecision-makersneedtorecognisethesevere,longtermhumanandeconomicimpactofallowingEIPservicestobedilutedorhollowedout.Notonlydoesearlyinterventionhelppeoplerecoverandoffersavings,itsaveslives.

Thereisonlyonewaytoavoidwritingoffagenerationofyoungpeoplewithpsychosis,andthatistosecurethefutureofservicesthathavebeenproventowork.

•TheGovernment’smentalhealthstrategyhighlightstheimpressiveclinicaloutcomesachievedbyEIPservices,andthelongtermeconomicsavingstheyoffer.35

• TherecentlyupdatedNationalInstituteforHealthandCareExcellence(NICE)guidelinesonpsychosisandschizophreniarecommendthatanyoneexperiencingtheonsetofpsychosisshouldbeofferedEIPcareregardlessoftheirage.36

• TheGovernment’srecentmentalhealthactionplannotesthatearlyinterventioncanmakea“massivedifference”inaddressingmentalhealthproblemsamongyoungpeople.37


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3. TheCommissioningforQualityandInnovation(CQUIN)paymentframeworkenablescommissionerstorewardexcellencebylinkingaproportionofhealthcareproviders’incometotheachievementoflocalquality.NHSEngland,2013.Commissioning for quality and innovation (CQUIN): 2014/15 guidance.

4. TheIRISNetwork,2012.The IRIS Network Guidelines,http://www.iris-initiative.org.uk/.TheGuidelinessetoutadviceonthebestmodelofcareforpeopleexperiencingafirstepisodeofpsychosis.TheyareofferedbytheNationalinstituteforHealthandCareExcellence(NICE)asaresourceforimplementingNICEguidelinesonpsychosisandschizophrenia.

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