Improving Consistency in Access and Treatment in EIP

In 2019 , we noted a year on year decrease in the number of people able to access EIP from 4,130 in 2016 when the psychosis standards were first introduced, down to 3,780 in 2019.  Without the extra investment described in the Five Year Forward View and NHS Long Term Plan, EIP teams had reported that they struggled to achieve NICE concordance and meet the rise in demand which had resulted from the extended remit to include people aged over 35 and with At Risk Mental States (ARMS). To try and understand the issues facing EIP teams further, we organised workshops with team managers and clinical leads to explore some of key factors behind the decline in the number of people accessing EIP between 2016 and 2019:

  1. Many EIP teams struggled to find time to educate other teams about psychosis as part of early detection work
  2. Referrals were sometimes rejected by triage teams as they did not meet generic mental health teams’ thresholds
  3. Many EIP teams also struggled to recruit staff and resorted to employing new graduates with limited experience
  4. Due to the 14 day target, some teams were less flexible at assessment leading to rejection of complex cases
  5. Early discharges before the recommended 3 years had become more common as a way to gain throughput

Alongside continued work with commissioners to secure funding to increase the teams’ capacity, the group came up with the following actions in order to address the above concerns:

  1. Increase teams’ capacity so they can safely manage demand with flexibility to accept diagnostic uncertainty
  2. Provide regular e.g. quarterly education sessions to referrers so they can spot early signs of psychosis
  3. Analyse instances of early discharge to determine and reduce reasons for premature discharge or disengagement
  4. Pre-plan training days in topics such as the role of trauma, emotion regulation and attachment styles in psychosis
  5. Use assessment tools e.g. the Positive and Negative Syndrome Scale (PANSS) for more objective clinical decisions
  6. Consider regular group supervision with external facilitator to prevent compassion fatigue and disillusionment

Improving Consistency in Access and Treatment in EIP [Slide Deck]