Early intervention services

What are early intervention services?

Early intervention services are specialist services, available across England (and in many other countries) that were set up to provide treatment and support for young people who are experiencing symptoms of psychosis for the first time, and during the first three years following a first episode of psychosis.

Early intervention services are run differently in different parts of the country, but all aim to give young people and their families a wide range of help, treatment and support – information to help them make sense of what’s happening, for example, talking therapies like family therapy and cognitive behaviour therapy as well as medication. Early intervention teams also help people get back to, or continue to, work or study, and liaise with other services and agencies to sort out benefits and finances, and help solve any housing problems.

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Do early intervention services make a difference?

The earlier someone who is experiencing the symptoms of psychosis gets treatment, the better. A number of research studies have reported that the longer people go without having treatment, the harder it is to start the process of recovery. Early intervention services were designed to give people quick and easy access to treatment when they first become unwell.

Researchers have followed people who have been supported by mental health professionals working in early intervention services and compared the course of their illness with the experiences of people who have been treated in other types of mental health services, such as community mental health teams. The studies have consistently shown that within two years, people who have accessed early intervention services have fewer relapses, are less likely to be admitted to hospital, and have less severe symptoms. Importantly too, people who have been supported by early intervention services, and their family members, say they prefer them to other types of mental health services.

The success of early intervention services has led the National Institute for Health and Care Excellence (NICE) to recommend in its 2014 guideline about psychosis and schizophrenia* that everyone who is experiencing a first episode of psychosis should be able to access them, regardless of their age.

However, studies that have followed people for more than two years don't always show longer-term benefits when they stop receiving specialist support from early intervention services. The 2014 NICE guideline about psychosis and schizophrenia* says that in some instances, people should be supported by early intervention teams for longer than three years.

*Psychosis and Schizophrenia in adults, NICE Guideline on Treatment and Management, updated edition 2014, does not include recommendations about treatment for people who experience psychosis as a symptom of bipolar disorder, psychotic depression, dementia or Parkinson's disease. These recommendations are contained in other NICE guidance.

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Who works in early intervention services?

Early intervention teams are usually made up of a range of mental health professionals, including psychiatrists, psychologists, mental health nurses and social workers. Some teams include vocational advisors or employment support workers. Many of the people who work in early intervention services are specialists trained to work in this field. (The Institute of Psychiatry, King's College London, runs an MSc in Early Intervention in Psychosis to train people to carry out specialist early intervention work and to carry out research than can help develop services.)

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Treatment for people who are experiencing their first episode of psychosis

If your relative is experiencing the symptoms of psychosis for the first time, he or she should be assessed by mental health professional who should ask not only about their current symptoms, but also about other mental health problems, their physical health and their medical history. The mental health professional should ask too about the impact of the symptoms on your relative's life, including their job or education, and their friendship circles.

The 2014 National Institute for Health and Care Excellence (NICE) guideline about treatment for psychosis and schizophrenia* recommends people who are experiencing a first episode of psychosis are offered antipsychotic medication (to be taken as a tablet or in liquid form).

Mental health professionals should work with your relative to decide which medication to prescribe in the first instance, and, if your relative agrees, they should consult you or other family members. You should all be given information and be able to discuss benefits and possible side effects of each drug with mental health professionals.

Before starting on antipsychotic medication, NICE recommends* mental health professionals carry out a series of physical health checks. They should continue to monitor your relative's physical health for the following year, or until your relative's condition has stabilised. Initially, they should prescribe antipsychotics at a low dose and then increase the dose slowly. Mental health professionals should regularly check how your relative responds to the medication and the increasing dose – and should be looking for changes in symptoms and behaviour, side effects, any weight gain, or any change in pulse and blood pressure.

The NICE guideline* also suggests health professionals offer family intervention and cognitive behaviour therapy to people who are experiencing psychosis for the first time. These talking therapies should be delivered by people who have had specialist training. Family therapy may sometimes be given with other families, if everyone involved agrees to that happening.

When people first become unwell, some may want to try treating their symptoms using only talking therapies, without medication. The 2014 NICE guideline* stresses that CBT for psychosis and family therapy are proven to be more effective when given with medication. However, if someone wants to try family therapy and CBT without medication, NICE recommends* a short trial (up to a month) of talking therapies only. During that time, mental health professionals should monitor their symptoms and when treatment is reviewed, antipsychotics should once again be considered.

Mental health professionals will often not offer a diagnosis following a first episode of psychosis (See Mental health diagnoses page). Because the symptoms of psychosis may be present in a number of different mental illnesses, diagnosis if often not clear-cut. However, if mental health professionals do diagnose bipolar disorder or psychotic depression, the treatment they offer should be in line with NICE guidance about these conditions.

*Psychosis and Schizophrenia in adults, NICE Guideline on Treatment and Management, updated edition 2014, does not include recommendations about treatment for people who experience psychosis as a symptom of bipolar disorder, psychotic depression, dementia or Parkinson's disease. These recommendations are contained in other NICE guidance.

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Helping people who have 'prodromal’ symptoms

Some early intervention services also work with young people who are having experiences that could be 'warning signs' – psychotic-like experiences that may lead to the development of the symptoms of psychosis. Doctors call these early experiences ‘prodromal’ symptoms.

People may begin to feel confused and find it hard to cope with life, or have unusual and strange experiences, like seeing or hearing things that aren’t there. They may be anxious, or irritable, or depressed, and find it hard to sleep, or need to sleep much more than usual. They may stop wanting to spend time with family members and friends and shut themselves away. They may feel persecuted or harassed (see Paranoia page), or out of control, or feel that something peculiar is happening but not be able to identify what it is.

Researchers describe people who are having these sort of experiences as 'high risk', 'ultra high risk' (UHR), 'clinically high risk' or as being in an 'at risk mental state (ARMS)'. People who have these symptoms are more likely to develop psychosis than their peers. However, not everyone who experiences prodromal symptoms goes on to develop the symptoms of psychosis (see Psychotic-like experiences page).

The National Institute for Health and Care Excellence (NICE) recommends in its 2014 guideline about psychosis and schizophrenia* that people who are experiencing distressing symptoms of this nature should be assessed by a consultant psychiatrist or trained specialist who has experience of 'at risk mental states'.

Mental health professionals may suggest cognitive behaviour therapy and family therapy. They may also suggest treatment recommended by NICE for anxiety, depression, personality disorder or substance abuse, if appropriate. Mental health professionals should not prescribe antipsychotic medication to people who they think may be at risk of developing psychosis, or as a preventative measure.

*Psychosis and Schizophrenia in adults, NICE Guideline on Treatment and Management, updated edition 2014, does not include recommendations about treatment for people who experience psychosis as a symptom of bipolar disorder, psychotic depression, dementia or Parkinson's disease. These recommendations are contained in other NICE guidance.

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How to contact your local early intervention service

Ask your GP how to contact your local early intervention service, or visit the website of your local mental health NHS trust and search for 'early intervention'. In some parts of the country, people can ring up and self-refer. The 2014 NICE guideline* about psychosis and schizophrenia recommends that people should be able to refer themselves, or be referred by a family member.

Early intervention services aim to see people as quickly as possible.

However, 'Lost Generation', a report from the charity Rethink Mental Illness and the IRIS Network (made up of people who support early intervention for psychosis) says early intervention services are being cut back in many parts of England.

The two organisations collected information from early intervention services and teams in England during December 2013 and January 2014. More than 75 per cent of services and teams responded to the survey and half said their budget had been cut in the previous year. 58 per cent reported losing members of staff during the last 12 months with a subsequent reduction in the number of treatments and amount of support they offer. 53 per cent said the quality of the service they offer has decreased.

'Lost Generation' was published in March 2014 and you can download a copy of the report from the Rethink Mental Illness website.

The NICE 2014 guideline about psychosis and schizophrenia* says that if an early intervention service cannot offer an urgent assessment, someone who is experiencing an episode of psychosis should be referred to a crisis resolution/home treatment team.

*Psychosis and Schizophrenia in adults, NICE Guideline on Treatment and Management, updated edition 2014, does not include recommendations about treatment for people who experience psychosis as a symptom of bipolar disorder, psychotic depression, dementia or Parkinson's disease. These recommendations are contained in other NICE guidance.

 

 


This page was updated on 16 April 2014
Links on this page last checked: 31 July 2014
Next links check due: December 2014


Other useful websites

Am I Ok?

This is the website of Bucks Early Intervention Service run by Oxford Health NHS Foundation Trust. It contains information that may be useful to young people who are finding life difficult. 


Young Minds

Information for young people and their parents. The charity runs a telephone helpline service for parents who are worried or want to find out about different mental health problems and treatment options: 0808 802 5544, weekdays, 9.30am to 4pm.