Yorkshire and the Humber Mental Health Network Early Intervention in Psychosis Network 17 th November 2016 • Stephen McGowan, EIP Clinical Lead for Y&H CN and NHSE (North) (Chair) • Dr Steve Wright, Consultant Psychiatrist, TEWV (Co-Chair) • Rebecca Campbell, Quality Improvement Manager and Sarah Boul, Quality Improvement Lead • Rebecca.campbell6@nhs.net and sarah.boul@nhs.net • Twitter: @YHSCN_MHDN #yhmentalhealth • November 2016 www.england.nhs.uk
Yorkshire and the Humber Early Intervention in Psychosis Network Welcome! Rebecca Campbell, Quality Improvement Manager, Yorkshire and the Humber Clinical Networks www.england.nhs.uk
Housekeeping: @YHSCN_MHDN #yhmentalhealth Add CODE!!
Introductions: • Aspire Leeds Early Intervention Service • Bradford & Airedale Early Intervention Service • Calderdale Insight Early Intervention Team (SWYPFT) • Kirklees Insight Early Intervention Team (SWYPFT) • Wakefield Insight Early Intervention Team (SWYPFT) • Barnsley Insight Early Intervention Team (SWYPFT) • Sheffield Health and Social Care NHS Foundation Trust Early Intervention Services • Doncaster Early Interventions In Psychosis Service (RDASH) • Rotherham Early Intervention Psychosis Team (RDASH) • North Lincolnshire Early Intervention in Psychosis Team (RDASH) • Psypher (Humber NHS FT) • NAViGO Care Early Intervention Team • York and Selby Early Intervention Team (TEWV) • Leeds & York Partnership NHS FT www.england.nhs.uk
More Introductions: • RDASH – Manchester • Lancashire Care NHS FT CYP: • Leeds Community Healthcare NHS Trust • Lincolnshire Partnership NHS Trust CAMHS • Bradford District Care Trust • Sheffield Community CAMHS • York CAMHS Service • Bradford IAPT Services • Hull University • CCGs • NHS England (North) • Health Education England • Intensive Support Team (NHS Improvement) • Yorkshire & the Humber Clinical Networks (Adult MH, Dementia & Older People’s MH, CYP MH)
Clinical Networks • Clinical Networks operate as engines for change across complex systems of care, maintaining and or improving quality and outcomes. • Support mental health commissioners and providers to facilitate quality improvement in mental health services working across organisational boundaries with a wide range of NHS and non NHS stakeholders • Hosted by NHS England and receive national commissioning funding for their core functions. Within Yorkshire and the Humber the Clinical Network is hosted by the District Commissioning Office of NHS England in Yorkshire and the Humber. • Mental Health and Dementia Team is part of wider Clinical Network family: Cardiovascular Disease, Cancer and CYP MH & Maternity • Cross network working with Public Health England, Health Education England, Emergency Services, Social Care, Third Sector and patient charities • Focus on the 5YFV MH Taskforce Recommendations
The “Pillars” of Mental Health Early Intervention in Psychosis Children & Young People’s Mental Health Increasing Access to Psychological Therapies Community Eating Services Liaison Mental Health Perinatal Mental Health Crisis Care Dementia
Agenda: Moggie McGowan, Clinical Advisor (Y&H 13:40 National & Regional Update IRIS & NHS England North) Prof Paul French, EIP Clinical Advisor, 14:00 At Risk Mental State (ARMS) Interventions Greater Manchester Clinical Network 14:30 Questions & Discussion All Moggie McGowan, Clinical Advisor (Y&H 14:45 Summary & Supervision IRIS & NHS England North) 14:50 Break Dr Steve Wright, Consultant Psychiatrist, 15:05 Introduction to Group Discussions TEWV 15:20 Group Discussion – At Risk Mental State All 16:00 Feedback from Table Top Discussions All Any Other Business - Future Meeting Planning Dr Steve Wright, Consultant Psychiatrist, 16:20 - Closing Remarks TEWV Evaluation -
Yorkshire and the Humber Early Intervention in Psychosis Network National and Regional Update Moggie McGowan, EIP Clinical Advisor, Yorkshire and the Humber IRIS and NHS England North www.england.nhs.uk
Three Gifts
Gold
£70 million!
Understanding Demand • Fingertips? • Local experience? • ARMS?
On-line workforce Calculator https://www.myhealth.london.nhs.uk/your- health/psychosis/workforce-calculator
Frankincense
Help with both performance objectives: From 1 April 2016 more than 50% of people experiencing first episode psychosis will be treated with: A NICE-approved care package Support with MHSDS EIP data requirements Caroline Coxon & Michael Watson, Intensive Support Managers, Mental Health Strategy and Policy Unit, NHS England Within two weeks of referral. EIPN Self-Assessment Scoring Matrix (CCQI)
Myrrh
Prof Paul French, EIP Clinical Advisor, Greater Manchester Clinical Network At Risk Mental State (ARMS) Interventions
Yorkshire and the Humber Early Intervention in Psychosis Network At Risk Mental State (ARMS) Interventions Prof Paul French, EIP Clinical Advisor, Greater Manchester Clinical Network www.england.nhs.uk
Preventing psychosis and targeting people at risk: From bright idea to NICE Guidelines Paul French
Overview Introduction and rationale Identification including CAARMS Psychological interventions
Psychosis: The Early Course Adapted from Larsen et al., 2001 Early Intervention in the at- Early Intervention after Psychosis risk phase ARMS onset of psychosis (EIS) Tertiary Prevention 1 st treatment Premorbid Phase Very Early Symptoms Psychotic Symptoms The typical course of psychosis
Buckingham Project UK Falloon 1985 • GP’s trained to identify early psychosis symptoms • Referred to specialist team for assessment • Those with positive early symptoms treated with low dose medication, crisis and family intervention • Outcome: 10 fold reduction in schizophrenia over 4 years • But several methodological shortcomings (including small n)
Identification
Age of onset for schizophrenia Females % Males % 35 30 25 Percentage 20 15 10 5 0 age age age age age 30 age age age age 50 age 12-14 15-19 20-24 25-29 34 35-39 40-44 45-49 54 55-59
PACE referral criteria • Age between 14 and 30 years AND • Family history of DSM-IV psychotic disorder and reduction on GAF scale of ≥ 30, AND/OR • Attenuated symptoms, occurring several times during the week for at least one week AND/OR • Brief, limited or intermittent psychotic symptoms (BLIPS) for less than one week and resolving spontaneously
Prediction of Psychosis Yung et al 1998 British Journal of Psychiatry 40% made Number transition at six not months, 50% at psychotic one year Months of assessment
Assessments for identification • Brief Psychiatric Rating Scale (BPRS) Lukoff, Neuchterlein & Ventura (1993) • Positive And Negative Syndromes Scale (PANSS) Kay, Fiszbein & Opler (1987) • Comprehensive Assessment of At Risk Mental States (CAARMS) Pace clinic Yung et al 2002 • Structure Interview for Prodromal Symptoms (SIPS) Scale of Prodromal Symptoms (SOPS) Prime clinic McGlashen, Miller, Woods, Rosen, Hoffman & Davidson • Bonn Scale for the Assessment of Basic Symptoms (BSABS) Klosterkoette, Schultze-Lutter
Identification of young people in the early stages of psychosis: Validation of a checklist for use in primary care. French, Owens, Parker, Dunn Psychiatric Research, • Preliminary analysis found that the simple 2012 checklist as originally conceived had excellent sensitivity (96%) but poor specificity (10%). • The first retained the use of all 20 checklist items and achieved sensitivity of 89% and specificity of 60% (altered scoring) • The second retained 6 checklist items and achieved sensitivity of 88% and specificity of 47%.
If a total score of more than +1.0 then refer
Transition rates? • Meta analysis on transition Fusar-Poli et al 2012 Archives • Twenty-seven studies met the inclusion criteria, comprising a total of 2502 patients. • There was a consistent transition risk,18% after 6 months of follow-up, 22% after 1 year, 29% after 2 years, and 36% after 3 years. • There was no publication bias, and a sensitivity analysis confirmed the robustness of the core findings.
Intervention
What prevention strategy • Mrazek and Haggerty (1994) have discussed the idea of preventative interventions and identified three prevention strategies. These are: • Universal all of the population • Selective specific risk factors • Indicated minimal, but detectable, signs of psychosis
Prevention of psychosis McGorry et al 2002 Archives of General Psychiatry % making transition to psychosis Months n=58
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