scholarly journals Early Intervention Services for First Episode of Psychosis in South London and the Maudsley (SLaM): 20 Years of Care and Research for Young People

2020 ◽  
Vol 11 ◽  
Author(s):  
Paolo Fusar-Poli ◽  
Serena Lai ◽  
Marta Di Forti ◽  
Eduardo Iacoponi ◽  
Graham Thornicroft ◽  
...  
Keyword(s):  
Early Intervention ◽  
Clinical Research ◽  
Psychiatric Hospitals ◽  
First Episode ◽  
Scientific Publications ◽  
Early Intervention Services ◽  
White Ethnicity ◽  
Service Characteristics ◽  
Accident And Emergency ◽  
The Uk

Introduction: Early Intervention for a first episode of Psychosis (EI) is essential to improve outcomes. There is limited research describing real-world implementation of EI services.Method: Analysis of service characteristics, outcomes (described through a retrospective 2007–2017 Electronic Health Record (EHR) cohort study) and clinical research relating to the first 20 years of implementation of EI services in South London and Maudsley (SLaM) Trust.Results: SLaM EI are standalone services serving 443,050 young individuals in South-London, where (2017) incidence of psychosis (58.3–71.9 cases per 100,000 person-years) is greater than the national average. From 2007–2017 (when the EHR was established), 1,200 individuals (62.67% male, mean age 24.38 years, 88.17% single; two-thirds of non-white ethnicity) received NICE-compliant EI care. Pathways to EI services came mainly (75.26%) through inpatient (39.83%) or community (19.33%) mental health services or Accident and Emergency departments (A&E) (16%). At 6 year follow-up 34.92% of patients were still being prescribed antipsychotics. The 3 month and 6 year cumulative proportions of those receiving clozapine were 0.75 and 7.33%; those compulsorily admitted to psychiatric hospitals 26.92 and 57.25%; those admitted to physical health hospitals 6.83 and 31.17%, respectively. Average 3 months and 6 year days spent in hospital were 0.82 and 1.85, respectively; mean 6 year attendance at A&E was 3.01. SLaM EI clinical research attracted £58 million grant income and numerous high-impact scientific publications.Conclusions: SLaM EI services represent one of the largest, most established services of its kind, and are a leading model for development of similar services in the UK and worldwide.

Views of Young People in Early Intervention Services for First-Episode Psychosis in England

2011 ◽  
Vol 62 (8) ◽  
pp. 882-887 ◽  
Author(s):  
Helen Lester ◽  
Max Marshall ◽  
Peter Jones ◽  
David Fowler ◽  
Tim Amos ◽  
...  
Keyword(s):  
Early Intervention ◽  
Young People ◽  
First Episode Psychosis ◽  
First Episode ◽  
Early Intervention Services ◽  
Episode Psychosis ◽  
Intervention Services

scholarly journals Context and contact: a comparison of patient and family engagement with early intervention services for psychosis in India and Canada

2020 ◽  
pp. 1-10
Author(s):  
Srividya N. Iyer ◽  
Ashok Malla ◽  
Aarati Taksal ◽  
Anika Maraj ◽  
Greeshma Mohan ◽  
...  
Keyword(s):  
Early Intervention ◽  
Family Involvement ◽  
Proportional Hazards ◽  
Family Engagement ◽  
Cox Proportional Hazards ◽  
First Episode ◽  
Early Intervention Services ◽  
Service Engagement ◽  
Intervention Services ◽  
Family Contact

Abstract Background It is unknown whether patient disengagement from early intervention services for psychosis is as prevalent in low- and middle-income countries (LMICs) like India, as it is in high-income countries (HICs). Addressing this gap, we studied two first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized lower service disengagement among patients and higher engagement among families in Chennai, and that family engagement would mediate cross-site differences in patient disengagement. Methods Sites were compared on their 2-year patient disengagement and family engagement rates conducting time-to-event analyses and independent samples t tests on monthly contact data. Along with site and family involvement, Cox proportional hazards regression included known predictors of patient disengagement (e.g. gender). Results The study included data about 333 patients (165 in Montreal, 168 in Chennai) and their family members (156 in Montreal, 168 in Chennai). More Montreal patients (19%) disengaged before 24 months than Chennai patients (1%), χ2(1, N = 333) = 28.87, p < 0.001. Chennai families had more contact with clinicians throughout treatment (Cohen's d = −1.28). Family contact significantly predicted patient disengagement in Montreal (HR = 0.87, 95% CI 0.81–0.93). Unlike in Chennai, family contact declined over time in Montreal, with clinicians perceiving such contact as not necessary (Cohen's d = 1.73). Conclusions This is the first investigation of early psychosis service engagement across a HIC and an LMIC. Patient and family engagement was strikingly higher in Chennai. Maintaining family contact may benefit patient engagement, irrespective of context. Findings also suggest that differential service utilization may underpin cross-cultural variations in psychosis outcomes.

scholarly journals Loneliness in early psychosis: A qualitative study exploring the views of mental health practitioners in early intervention services

2020 ◽  
Author(s):  
Theodora Stefanidou ◽  
Jingyi Wang ◽  
Nicola Morant ◽  
Brynmor Lloyd-Evans ◽  
Sonia Johnson
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Public Health Problem ◽  
Early Psychosis ◽  
Mental Health Practitioners ◽  
First Episode ◽  
Physical And Mental Health ◽  
Early Intervention Services ◽  
Health Practitioners ◽  
Intervention Services

Abstract Background: Loneliness is an important public health problem with established adverse effects on physical and mental health. Although, people with psychosis often experience high levels of loneliness, relatively little is known about the relationship between loneliness and early psychosis. Potential interventions to address loneliness might be easier to implement early in the illness when social networks and social skills may be more intact than at a later stage. We investigated the views of mental health practitioners about the context and causes of loneliness in people with early psychosis, and about potential interventions.Methods: Semi-structured face-to-face interviews were conducted with mental health practitioners (n=20). Participants were purposively recruited from four early intervention services for first-episode psychosis in the UK. Interviews were transcribed verbatim and thematic analysis was conducted.Results: Participants believed that the majority of service users with early psychosis experience feelings of loneliness. They often saw socially isolated and disconnected clients and believed them to be lonely, but rarely discussed loneliness explicitly in clinical interactions. A combination of symptoms, stigma and negative sense of self were believed to underpin loneliness. Participants could not identify any specific current interventions delivered by their services for tackling loneliness, but thought some routinely provided interventions, including social groups and psychological treatments, could be helpful. They favoured making a wider range of loneliness interventions available and believed that community agencies beyond mental health services should be involved to make these effective and feasible to deliver. They suggested social participation interventions without an explicit mental health focus as potentially promising and valued a co-produced approach to intervention development. Conclusions: This study suggests that loneliness is not routinely discussed in early intervention services, and a targeted strategy for tackling it is lacking. Co-produced, individualised community approaches, and interventions that target symptoms, stigma and negative self-schemas might be beneficial in alleviating loneliness for people with early psychosis. Empirical research is needed to develop and test such interventions.

scholarly journals Early intervention in psychosis: obstacles and opportunities

2005 ◽  
Vol 11 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Swaran P. Singh ◽  
Helen L. Fisher
Keyword(s):  
Early Intervention ◽  
Psychotic Disorders ◽  
Evidence Base ◽  
Early Intervention Services ◽  
Department Of Health ◽  
Short And Long Term ◽  
Intervention Services ◽  
The Uk ◽  
Early Intervention In Psychosis

By focusing therapeutic effort on the early stages of psychotic disorders, effective early intervention should improve short- and long-term outcomes. Strategies include pre-psychotic and prodromal interventions to prevent emergence of psychosis, detecting untreated cases in the community and facilitating recovery in established cases of psychosis. The evidence base for each of these strategies is currently limited, although several international trials are under way. The Department of Health in the UK has announced the intention of setting up 50 early intervention services nationally, several of which are already operational. In this article, we briefly discuss the differing ways in which early intervention is conceptualised, summarise the evidence supporting it in established cases of psychosis, suggest appropriate service models and describe two early intervention services in south-west London.

scholarly journals Layers of listening: Qualitative analysis of the impact of early intervention services for first-episode psychosis on carers' experiences

2015 ◽  
Vol 207 (2) ◽  
pp. 135-142 ◽  
Author(s):  
Anna Lavis ◽  
Helen Lester ◽  
Linda Everard ◽  
Nicholas Freemantle ◽  
Tim Amos ◽  
...  
Keyword(s):  
Early Intervention ◽  
Young People ◽  
Help Seeking ◽  
Young Person ◽  
First Episode Psychosis ◽  
First Episode ◽  
Early Intervention Services ◽  
Episode Psychosis ◽  
Intervention Services ◽  
The Impact

BackgroundEarly intervention services (EIS) comprise low-stigma, youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice.AimsBy analysing carers' accounts of their daily lives and affective challenges during a relative's FEP against the background of wider research into EIS, this paper explores relationships between carers' experiences and EIS.MethodSemi-structured longitudinal interviews with 80 carers of young people with FEP treated through English EIS.ResultsOur data suggest that EIS successfully aid carers to support their relatives, particularly through the provision of knowledge about psychosis and medications. However, paradoxical ramifications of these user-focused engagements also emerge; they risk leaving carers' emotions unacknowledged and compounding an existing lack of help-seeking.ConclusionsBy focusing on EIS's engagements with carers, this paper draws attention to an urgent broader question: as a continuing emphasis on care outside the clinic space places family members at the heart of the care of those with severe mental illness, we ask: who can, and should, support carers, and in what ways?

Sign in / Sign up

Export Citation Format

Share Document