On the eighth day of Christmas, the cuts took away… Early Intervention (EI) in psychosis services

Here ‘Mary’ and ‘Jo’ tell their story of the ‘radical redesign’:

“We have worked in Early Intervention (EI) in psychosis for nearly twenty years between us. EI is our passion, it has a strong evidence base and it is the service that all have a right to, regardless of where they live.

Early Intervention in psychosis teams work with people in the first three years after the development of psychotic symptoms. This is important because the level of disability resulting from psychosis increases in the first couple of years if support isn’t received. The suicide rate is also highest in the first five years, with most suicides occurring after the first psychotic episode, generally in the period of stability when services would traditionally reduce their input.

EI services offer a range of evidence-based interventions including case management (workers who work closely and intensively with the person and their family), family intervention, Cognitive Behavioural Therapy (CBT) and medication within an evidence-based service model. Early Intervention teams have been shown reduce the need for hospital admissions and increase service user engagement in education and employment, thus improving their quality of life and reducing the need for some welfare benefits. Research has demonstrated that the saving per service user who receives a three year Early Intervention service is £14,500 when compared to generic mental health services. Given all of this we have to ask why our Trust, Norfolk & Suffolk NHS Foundation Trust (NSFT) has almost entirely disbanded Early Intervention teams.

In Suffolk, people with a first episode of psychosis are now seen by generic teams – EI teams have disappeared entirely. In King’s Lynn, there are only two specialist workers based in generic teams each with a caseload almost twice the recommended size. Sticking the job title ‘Early Intervention Worker’ on someone does not make them able to provide the full range of intensive support that the Department of Health policy implementation sets out. If the model is diluted, even the most skilled clinicians cannot deliver a true Early Intervention service without the resources to do so. Great Yarmouth and Waveney has an Early Intervention team but have seen the size of the team significantly reduced from the agreed redesign size and has only limited access to key interventions such as CBT. Only central Norfolk has maintained a functional Early Intervention team, albeit also reduced in size.

These cuts are taking place despite the evidence from research within NSFT showing that the benefits of Early Intervention only occur if staff are based in a dedicated Early Intervention team with small caseloads and dedicated input from a range of professionals. This may sound expensive but remember – research has shown it to be £14,500 cheaper per service user cheaper than the alternative.

If we’re aiming for efficient services with reduced bed usage (as the NSFT Board keep telling us) then Early Intervention has evidence demonstrating its ability to deliver this objective. Nevertheless, NSFT keeps cutting EI services, leaving some of the most vulnerable service users to struggle with little to no support. It leaves family members struggling to cope and fighting to try to get their loved ones support they desperately need. This is not an efficiency saving – so if it’s not about efficiency what is it about?

If NSFT attempt to deny these truths, then we challenge them:

• to publish an audit using the ‘Early Intervention Fidelity Scale’ of the care of everyone who meets the criteria for an early intervention in psychosis service;
• to publish the caseload size of each early intervention care co-ordinator so we can compare how close to the recommended size they are (15 per full time band 6 care co-ordinator).
• to explain why, if the ‘radical redesign’ is truly evidence-based, there four different models of EI service in one Trust?”

The ‘radical redesign’ should contain an Elf & Safety warning.

You can discover more about Early Intervention in psychosis teams here (pdf).