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Treatments for psychosis; how the NHS has pioneered new research and service models to improve outcomes. Paul French
Treatments for psychosis; how the
NHS has pioneered new research and service models to improve outcomes.
Paul French
Promoting recovery in psychosis
• For many years a diagnosis associated with psychosis was assumed to be catastrophic.
• Don’t talk to people about their hallucinations. • Stories of clinicians saying you would be better off with cancer. • We have known about 20 year loss of life compared to peers for a long
time.
• “all these recovery messages not helpful for those people that don’t recover”
Perceptions of mental health and mental illness have changed
Policy Implementation Guidelines
• Introduction of EIP services in 1998 as part of the National Service Framework
• Promoted the importance of working with people in their First Episode of Psychosis
What does an early psychosis team do
1. Highlighted the possibility to prevent psychosis in the ultra high risk individuals
2. Reduce DUP (Duration of Untreated Psychosis):
3. Optimise initial experience of acute care & treatment:
4. Maximise recovery & prevent relapse during critical period:
Age of onset for schizophrenia
0
5
10
15
20
25
30
35
age
12-14
age
15-19
age
20-24
age
25-29
age 30
34
age
35-39
age
40-44
age
45-49
age 50
54
age
55-59
Pe
rce
nta
ge
Females %
Males %
“The jewel in the crown of the NHS mental health reform because:
• Service users like it
• People get better
• It saves money”
Professor Louis Appleby;
Track conference
Birmingham April 29th 2009
Lost generation report published by RETHINK 2014
Ministerial announcement
Access and Waiting Times Standard for Psychosis
• More than 50% of people experiencing a first episode of psychosis will be treated with a NICE approved care package within two weeks of referral (Rising to 60% by 2020)
2 parts
Part 1 - get people access quickly 2 weeks
Part 2 – get people the right interventions
How are we doing
0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0%
ENGLAND
NORTH OF ENGLAND
MIDLANDS AND EAST OF ENGLAND
LONDON
SOUTH WEST OF ENGLAND
SOUTH EAST OF ENGLAND
Start of Treatment
People started Treatment within 12 weeks % People started Treatment within 6 weeks % People started Treatment within 2 weeks %
Interventions to maximise outcomes associated with a First Episode of Psychosis
• Referral to EIP and start treatment within 2 weeks
• Offer CBT for Psychosis
• Offer Family Interventions
• Offer Clozapine (if not responded to other meds)
• Provide Supported Employment Programmes
• Assessment of Physical Health
• Promoting Healthy Lifestyles (exercise, smoking cessation, diet)
• Offer carer focused education and support
kg
Months 12 24 0 48 36
Established Psychosis RCTs
10
5
20
15
12 kg
4 kg
3 kg
Alvarez-Jimenez et al; CNS Drugs, 2008 22: 547-562
Antipsychotic-Induced Weight Gain in Chronic and First-Episode Psychotic Disorders: a Systematic Critical Reappraisal
First episode of psychosis RCTs
Established psychosis RCTs
Jo Hodgekins, Paul French, Max Birchwood, Miranda Mugford, Rose Christopher, Max Marshall, Linda Everard Helen Lester, Peter Jones, Tim Amos, Swaran Singh, Vimal Sharma, Anthony P. Morrison, David Fowler Schizophrenia Research 2015
0
10
20
30
40
50
60
70
General Population At Risk of Psychosis First Episode Psychosis Delayed Recovery
Weekly Hours Time Use Across Different Groups
Meddian Hours Mean Hours
In conclusion
• EIP services are well and truly embedded within clinical practice right across the NHS in England
• Theses services have achieved a huge amount over the past couple of years to see people within a 2 week time frame – internationally recognised
• We are now evaluating what interventions are offered to individuals and their families to promote recovery and measuring whether this is achieved
• We are the only country in the world that measure delays to services for people with psychosis in days and weeks not months and years.
• Cancer UK – more than 25,000 patients joined clinical trials last year - we need to encourage research across our services and ensure people get access to early trials and we make the most of research opportunities.
