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RDaSH leading the way with care
Rotherham Early Intervention Team
Information for service users and carers
Most people who come into contact with mental health services for
the first time will feel apprehensive. Although one in four people
will experience mental ill-health in their life time for most this may
be their first direct experience of mental illness or mental health
services.
Early intervention teams support, treat and work with people aged
over 14, who may be experiencing a first episode of psychosis.
What is Psychosis?
One in 100 people will develop a psychotic illness in their life and
for the majority this will start between the ages of 15 and 30.
Everyone experiences times when they feel stressed, confused
or very upset; this is a normal response to difficult events and
situations. Feeling any of these things is not necessarily a sign
of mental illness, simply life events that we all face. However,
sometimes these feelings can last for a long time and begin to have
an impact on your life.
There is a lot of misunderstanding about what psychosis actually
means. It’s often mistaken to mean that a person is dangerous. The
way that the media portray psychosis can sometimes be unhelpful.
There is no suggestion that people with psychosis are any more
dangerous than anyone else. Sometimes people with psychosis may
respond angrily but this is usually due to fear or frustration just the
same as anyone else may react, it is not a sign of psychosis.
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Effect on families and friends
Family and friends (often called carers) may be the first people to
notice that something is wrong when a person experiences a mental
illness. They may feel confused and uncertain about why it has
happened, and may question themselves or the person’s childhood
experiences.
As a team we offer support to family and friends. This is called
Family Intervention (FI). We provide information and education about
psychosis and recovery. We also support carers in looking after their
own health and wellbeing. The idea is to help others understand
what is happening to their friend or relative and explore ways in
which they can help them. The team also uses the Triangle of Care
which brings together carers, service users and professionals with
the aim of promoting safety and recovery for people experiencing
mental health problems.
Keeping mentally well
There are things that we can all do to improve our mental health.
Look after yourself
This can mean trying your best to:
• Get a good night’s sleep – whenever you can, we have an
information booklet that can help people to improve their sleep,
we call this sleep hygiene.
• Eat right – try and eat as healthily as you can, we have lots of
information on healthy eating.
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• Drink sensibly – try and avoid too much alcohol or caffeine (these can
add to stress or low mood).
• Exercise, even a short walk around your neighbourhood will be
beneficial.
Be kind to yourself
Think how you would treat a friend if they were having a tough time:
• Be patient and understanding towards yourself, try and give yourself a
break sometimes, don’t be over critical of yourself or kick yourself too
hard.
• Try and do at least one thing you enjoy every day
• Try and make time for yourself to relax, we use relaxation and
mindfulness techniques as a key part of treatment.
• Instead of being critical of yourself, tell yourself what you or others
like about you.
Stay in touch with people
Lots of people enjoy time to themselves, however stress can make people
withdraw from others completely, which can sometimes make them feel
lonelier and more worried.
• Try and contact one person a day – it’s easy to spend whole days or
weeks without speaking to anyone
• Try and go out of the house even just once a day – this can make you
feel more connected and be a good distraction
• Try to keep talking to people you care about and who care about you.
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Family and Friends are important
Family or friends can help by encouraging the person to seek
support.
Unusual thoughts and behaviour can be difficult aspects of mental
illness for family and friends to understand and cope with. They may
feel shocked, confused or frightened. The most helpful thing is to try
and remain calm and supportive. A safe and comforting environment
can also be reassuring for the person.
Psychotic episodes can occur after a stressful life event, such
as losing a close friend or relative. It can also be the result of a
physical illness (such as a severe infection) or the use of illicit drugs.
Sometimes it is difficult to know what has caused psychosis. This
is where the Early Intervention Team comes in. Your GP may have
referred you to us or a concerned member of your family may have
contacted us, you may have spoken to us yourself or your college,
school or university may have called us. We will spend a period of
time getting to know you and finding out about your experiences,
we call this a comprehensive assessment. During this assessment we
will try to understand your experiences and decide with you, the
best course of treatment, care or support.
First Episode Psychosis is the term we use to describe people, who
may be experiencing a range of psychotic symptom for the first time
these may include:
• Seeing, hearing, smelling or feeling something that other people
aren’t experiencing.
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• The most common experience that people have is hearing voices
that other people don’t hear. This can be very frightening and
can make you believe that you are being watched or picked on.
• You may think that there is a plot to harm you and feel worried
or suspicious about other people.
• You may believe that you are getting personal messages from
the TV or radio.
• You may feel that you have special powers.
• You may feel like you cannot think straight. Your ideas may seem
jumbled, but it is more than simply being muddled or confused.
Other people might find it very difficult to follow what you say.
• You may feel worried that other people can read or hear your
thoughts.
With a psychotic illness, you will often experience very unusual and
sometimes unpleasant thoughts and experiences. They may appear
suddenly or they can also creep up so gradually that only people like
your close family and friends notice that you are behaving oddly or
differently. They may make you feel very frightened and sometimes
you may feel ashamed, scared or embarrassed that you do not want
to talk about these experiences.
Having these strange thoughts and experiences can affect you
at school, work, home or social life. You may find it difficult to
concentrate and enjoy your usual activities. Your sleep and appetite
may also be poor.
At Risk Mental States (ARMS) is the term we use to describe people
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Referral directly to Early Intervention i.e. family, school, college etc.
No indication of psychosis
who may experience a relatively long period of less severe symptoms
or experienced a very short period of psychotic symptoms or an
extended period of poor social and cognitive (the way people think)
functioning, social isolation or withdrawal friends, family, study or
employment.
Sometimes people referred to the Early Intervention Team are taken
on for an extended period of assessment. This might happen where
the initial assessments are inconclusive or the clinical picture is
complicated by other factors, for example substance misuse.
Referral and Assessment Pathway
First Episode Psychosis
At Risk Mental State
Identified need for extended assessment
Max six months
Referral from Single Point of Access
Discussed in Multi-disciplinary
Team
Assessment by Early Intervention
Team
Signposted to relevant service
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What does the Early Intervention Team do?
We work with people in lots of different ways. This might involve
helping to try and make sense of what is happening, medication,
individual or family therapy, support with education or employment
or finances, physical or group activity. We aim to see people as
quickly as possible and give help that is specifically tailored to each
person and work closely with people and their families. We know
that the quicker that psychosis is treated, the better the prognosis
or recovery is likely to be. Psychotic experiences often happen at a
critical development stage in a young person’s life and so by getting
help early the disruption caused by psychosis can be significantly
lessened.
Early Intervention Teams are made up of a range of staff from
lots of different areas including administration and secretarial
staff, community psychiatric nurses, occupational therapists, social
workers, support workers psychologists and psychiatrists. The whole
team works together with the person to achieve their recovery.
Published by NHS England8 | Rotherham Early Intervention Team
The Recovery Ethos
The Rotherham Early Intervention Team promote recovery based
interventions in partnership with the service user
Recovery in mental health is not defined the same as recovery might
be in other health care settings. Recovery starts from ‘a strength’
approach which means focusing on maintaining the independence
of the individual – concentrating on what they can do not what they
can’t do. It is optimistic in its outlook refusing to accept that people
will be dependent on mental health services, welfare benefits and
medication for the rest of their lives. The person is encouraged to
achieve their individual potential.
Within a recovery approach the team implement the Care
Programme Approach (CPA) which is a framework for supporting
and treating people experiencing a mental disorder whilst living
within their community. Each service user will have a comprehensive
health and social assessment of their needs, detailed risk assessment
and individual care plan written in collaboration with their named
worker or care co-ordinator.
The Team Manager is responsible for maintaining clinical standards,
compliance with CPA and record keeping standards and this is
achieved by conducting data quality audits alongside clinical and
managerial supervision, team meeting and multi-disciplinary working
(MDT) arrangements.
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Treatment Pathways
Following the assessment period an individual plan of care and
treatment will be discussed with and written in collaboration with
the service user which may consists of medical treatment such as
medication, psychological treatments such Cognitive Behaviour
Therapy (CBT), group, social and health and wellbeing interventions.
The efficacy of planned care and treatment is evaluated using a
recognised evaluation tool the Process of Recovery Questionnaire
(QPR). The QPR assist to measure the process people are making
toward Recovery.
Once an individual is assessed as experiencing a First Episode of
Psychosis or At Risk Mental Health State Early Intervention Teams
aim to start treatment quickly, there are several reasons for this.
There are significant personal, social and health impacts on the
individual when treatment is delayed or is not effective. The cost of
not intervening early, prolonging the time that people experience a
psychosis without treatment, duration of Untreated Psychosis (DUP)
results in poor health outcomes and lengthy treatment of mental
health services.
In October 2014 NHS England published access and waiting time
standards for Early Intervention in Psychosis Services which requires
that more than 50% of people referred to Early Intervention teams
engage with the team within 14 days and more than 50% of people
experiencing first episode psychosis will be treated with a National
Institute of Health and Care Excellence (NIHCE) approved care
package within two weeks of referral. We routinely record data to
ensure this standard is maintained.
These access and waiting times are set to increase to at least 60%
by 2021.
NIHCE recommended treatments available from the Early
Intervention in Psychosis Team include:
• Cognitive Behaviour Therapy for Psychosis (CBTp)
• Family interventions (FI)
• Medication
• Physical Health Assessments and healthy lifestyle promotion
• Physical health interventions
• Educational and employment support
• Carer focused education and support.
Although the Early Intervention Team aim to prevent hospital
admission wherever possible, this is sometimes necessary. However if
service users require admission to an acute inpatient ward the team,
care coordinator or named professional will continue to remain
actively involved in the service user’s care, attending reviews on the
ward and planning discharge. All service users under the care of the
Early Intervention Team will be seen within seven days of discharge
from hospital.
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Effective coordination of care
All service users will have a named care coordinator or lead
professional who will ensure that effective community care plans are
implemented under the standards of the Care Programme Approach
Framework (CPA).
Core principles of the Care Programme Approach are:
• Comprehensive multi-disciplinary assessment covering a range of
health and social care needs.
• Assessment of social care needs in accordance with the 2015
Care Act.
• Comprehensive formal written care plans including risk,
contingency and crisis planning, service users will be offered a
copy of their individual care plan.
• On-going review and care plan evaluation at least once a year
although in reality this is likely to happen far more frequently
and will be evaluated as an individual’s needs change or when
elements of the care plan are achieved.
• On-going support for carers (family and friends) either informally
or within a formal structured framework will be offered
and carers will be informed of their right to receive a carer’s
assessment.
Compliance with Care Programme approach standards are
monitored in supervision by the team manager and are
supplemented by frequent audit of clinical records.
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Outcome measures
Two outcome measures are routinely used with the Early
Intervention Team in Rotherham.
The Health of the Nation Outcome Scale (HoNOS) developed by
the Royal College of Psychiatrists’ Research Unit (CRU) the scale
measures the health and social functioning of people with severe
mental illness. The initial aim was to provide a means of recording
progress towards the Health of the Nation target ‘to improve
significantly the health and social functioning of mentally ill people’
The Process of Recovery Questionnaire (QPR) is a self-rated
questionnaire completed by the service user.
Anonymous outcome data is shared with NHS England as part of
routine national data collection.
Discharge from the Early Intervention Team
Service users who are assessed as not experiencing psychosis at the
end of the assessment process with be discharged, signposted or
transferred to the appropriate service which may include primary or
secondary statutory services or voluntary, independent services.
Discharge will normally occur following three years of intervention
from the team, occasionally some individuals require extended
periods of treatment due to complexity or relapse for example and
therefore treatment interventions may be extended to five years.
The aim for the majority of service users is to be discharged back to
primary care services at the conclusion of treatment. However some
service users may need on-going specialist mental health care in
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which case care will be transferred to a Community Mental Health Team.
To facilitate a seamless transfer ensuring consistency of treatment transfers
will be conducted within the Care Programme Approach Framework and
arrangements will commence usually six months prior to discharge from
the Early Intervention team.
Occasionally service users chose not to engage with mental health service
and we respect anyone right to refuse health and social care however
prior to discharging anyone due to none engagement we need to be
confident that:
• They have the capacity (in accordance with the Mental Capacity Act
2005) to refuse treatment.
• The individual service users risk assessment does not identify any risk
that are unacceptable, to take with respect to service user choice,
within a model of positive risk taking.
• In accordance with the Trust Disengagement policies.
Supervision
All staff members receive clinical and managerial supervision in accordance
with Trust policy which includes an annual Personal Development Review.
Supervision arrangements include:
• Individual supervision from the Team Manager/Leader
• Informal adhoc peer and team supervision
• Formal peer group supervision including daily clinical meetings and
weekly multi-disciplinary meetings.
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Tell us if you’ve got something to say?
We at the Rotherham Early Intervention Team pride ourselves on
constantly trying to improve the services that we provide and the
experiences that people have who come into contact with the
team. We take all compliments, comments and complaints seriously
and use them to try and improve what we do. If you would like to
contact the Rotherham Team Manager either by telephone or in
writing please do so:
Phil Goodwin
Team Manager, Early Intervention Team
Rotherham Doncaster and South Humber NHS Foundation Trust
Swallownest Court,
Aughton Road
Swallownest
Sheffield S26 4TH
Telephone: 01709 447446
You can also contact the Patient Advice and Liaison Team (PALS) at:
Rotherham Doncaster and South Humber NHS Foundation Trust
Woodfield House
Tickhill Road Site
Tickhill Road
Balby
Doncaster DN4 8QN
Telephone ....................................................................................
Or online at http://www.rdash.nhs.ukwww.rdash.nhs.uk | 15
This information is correct at the time of publishing Last Reviewed: September 2017
geta p p r o v e d
DP8222/09.17
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