YOUNGMINDS MAGAZINE | Issue 112 June / July 2011 | 29 28 | Campaigning to improve mental health among children and young

people | www.youngminds.org.uk
KNOWLEDGE KNOWLEDGE
Where does EIIP discharge
to after three years?
Hospital admissions
3. Wong, C. , Davidson, L. , Anglin, D. , Link,
B. , Gerson, R. , Malaspina, D. , McGlashan,
T. , Corcoran, C. (2009) Stigma in
families of individuals in early stages
of psychotic illness: family stigma and
early psychosis. Early Intervention in
Psychiatry 3(2): 108-115.
4. WHO (2009) Milestones in Health
Promotion: Statements from Global
Conferences. http://bit.ly/e0IBID
5. Henquet, C. (2005) Prospective cohort
study of cannabis use, predisposition for
psychosis and psychotic symptoms in young
people. British Medical Journal, 330, 11-14.
6. McCrone P., Park A-L., & Knapp M. (2010)
Economic Evaluation of Early Intervention
(EI) Services: Phase IV Report. Personal
Social Services Research Unit (PSSRU)
Discussion Paper 2745.
Sarah Amani is the team manager for North
East Hants and Surrey Heath EIIP team
EARLY INTERVENTION IN PSYCHOSIS
To be aware and able
Efforts to raise awareness about mental health and psychosis in North East
Hampshire and Surrey aim to help young people access support earlier and
so achieve better outcomes. Sarah Amani outlines findings from the project
Psychosis affects 1–3% of the
population. An estimated 6,900 young
people aged 14–35 years old will deal
with an emerging psychosis in the UK
1
.
Each person’s experience of psychosis
will be different and therefore treatment
needs to be tailored according to each
individual’s experiences and needs. The
typical signs of psychosis include:
º Heaiing. seeing oi smelling rlings rlar
other people do not
º 1linking anu Lelieving rlar
everything is about or related to you
º Becoming µieoccuµieu virl susµicions
that others are out to harm you
º 1louglrs Leing íasrei oi slovei
º Ieeling as rlougl rlouglrs aie Leing
put in your head or disappearing.
Recent research into UK Early
Intervention in Psychosis Services
(EIIP) has shown better prognosis and
yearly savings of up to £290 million by
detecting and treating the symptoms of
psychosis early instead of waiting for the
illness to take a firm and permanent hold
2
.
EIIP works to detect and treat psychosis
early alongside the person and their
family. It focuses on broader outcomes
beyond symptom reduction, such as
facilitating the re-integration of a young
person into education, employment and
wider society. EIIP’s fundamental aims
can be summarised as to:
º Reuuce uuiarion oí unrieareu µsyclosis
(DUP) in order to achieve best
outcomes for individuals and families
accessing EIIP – where possible, prevent
chronic mental illness
º Lngage local communiries in
promoting health and reducing stigma
– this will make dialogue about mental
health and psychosis easier and lead to
more people seeking help early
º Assisr young µeoµle ro ieclaim an
ordinary life. This may include
efforts to reclaim family life, friends,
education, employment and other
aspirations.
The success of the above depends on
individuals and families being able to
access EIIP and mental health services
early. Identified barriers to this include
lack of awareness, shame and stigma
3
.
Negative associations with mental
illness can lead a young person and their
family to feel too ashamed to ask for help
from a GP. Additionally, parents report
hesitation due to fear of being blamed
and being labelled as a ‘bad’ parent or
being marginalised alongside the person
experiencing psychosis
4
.
EIIP undertook this comparative
study to:
º Lvaluare rle imµacr oí íocuseu lealrl
promotion activities on EIIP outcomes
º Sranuaiuise rle vay ve riack rle
progress of people who use EIIP during
the three years
º Be Lerrei aLle ro µieuicr iisk íacrois íoi
poor outcomes.
About the service
EIIP works with young people aged
14–35 with a first episode or at high risk
of developing psychosis for up to three
years. It aims to prevent rather than reverse
the effects of serious mental illness. This
framework was founded by Patrick
McGorry and colleagues in Australia
in 1989 and has led to increasing global
health reform. The first UK EIIP team was
developed in Birmingham in 2001 and
Surrey And Borders Partnership NHS
Foundation Trust (SABPFT) formed
its first EIIP in 2004. SABPFT now has
three EIIP teams covering East Surrey,
West Surrey and North East Hampshire
and Surrey Heath.
The World Health
Organisation defines health
promotion as “the process
of enabling people to
increase control over, and
to improve, their health”
4
.
EIIP undertook activities
aimed at raising awareness
of psychosis and the help
available. This included:
º Lngaging euucarional insrirurions
by attending local health fairs at
secondary schools, colleges and the
local university;
º Quaireily meerings virl local GPs
and primary care practitioners to raise
awareness of psychosis and EIIP;
º Involving young µeoµle vlo use LIIP
to co-create a youth orientated EIIP
website with accompanying leaflets,
posters and other promotional
materials (at www.sabp.nhs.uk/eiip).
Methodology
The EIIP team keeps a secure database
of all referrals to the service. All
person identifiable data was removed
to make this information anonymous.
Favourable ethical opinion was sought
and granted from the trust’s research and
development department. An audit was
then conducted and data was gathered on
the following:
º ÞumLei oí young µeoµle accessing rle
EIIP service and their gender
º Souices oí ieíeiial ro LIIP
º ÞumLei oí rlose aumirreu ro losµiral
in 2009 and 2010
º ÞumLei oí young µeoµle uisclaigeu
to primary care (GP) or secondary care
following three years of EIIP.
Results
In 2010, the total caseload of North East
Hampshire and Surrey Heath EIIP was 52.
Conclusions
While the results are promising, further
investigation is needed to determine if
health promotion can lead to sustained
improvements in health outcomes for
young people experiencing psychosis
who access EIIP. Further work is
required to equalise access to EIIP
regardless of demographics, increase
self-referrals by young people, their
families and GPs. This is likely to
reduce DUP and improve the long-
term prospects for those who have
experienced first episode psychosis. I
References
1. Department of Health (2011) Mental health
promotion and mental illness prevention:
The economic case, London, UK.
2. Jones, P., Shiers, D., Smith, J. (2010)
Early Intervention in Psychosis: Why a
specialised EIIP service model is preferable
to a CMHT model. http://bit.ly/dPuOVA.
Of this, 69% of people accessing the
service were male and 31% were female.
This difference in gender is not fully
understood. One hypothesis is that EIIP
efforts have traditionally been focused
on engaging hard to reach groups – such
as young males. While this might have
succeeded, it may have made the service
more male orientated and therefore less
likely to appeal to females. This is an area
yet to be thoroughly investigated.
The majority of referrals were from
local community mental health teams
(CMHTs). These usually originated from
GPs who had referred to CMHTs, who in
turn referred to EIIP. Meetings with GPs
revealed that some were still unaware
that they could refer directly to EIIP.
Some GPs did refer directly to EIIP and
these seemed to be GP surgeries that had
several visits from EIIP clinicians to raise
awareness of the EIIP service.
The third highest source of referrals
was from in-patient wards and self-
referrals. Anecdotal accounts of events
leading up to admission often pointed
to several weeks of deterioration in
the young person’s mental health.
Professionals and non-professionals
alike sometimes mistakenly dismissed
this deterioration as behavioural
problems or “teenage angst”.
Young people referred from
substance misuse services reported using
a range of substances including cannabis.
There is evidence to show that long-
term use of cannabis can increase the
risk of psychosis and that young people
experiencing psychosis may turn to
cannabis as a means of self-medicating
6
.
EIIP achieved a 75% reduction in
admissions to acute in-patient units and
50% reduction in admissions under
Mental Health Act (1983) sectioning
(formal admissions) powers. There
is clear evidence from peer reviewed
studies that shows less use of emergency
and in-patient services results in more
cost effective illness management
7
.
Following three years of EIIP, 65%
of people who had received care were
discharged back to their GPs. This
was following a tailored and phased
approach to offering interventions
according to individual needs. The process
of discharging to GPs is prepared for well
in advance (no less than six months
before discharge) so that the individual
and their family is prepared for less
intensive input.
0
5
10
15
20
0
2
4
6
8
Formal admissions to hospital
2009 2009 2010 2010
Community Mental Health Teams Community Mental Health Team
GP GP
Self Referral
In-patient Ward
Substance Misuse Services
Education
Criminal Justice System
Source of referrals 2010
4%
4%
10%
10%
15%
2%
55% 65%
35%
The North East Hampshire and
Surrey Heath EIIP team at
a mental health awareness fair

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