April 7, 2021
By Louise Beattie a*, Hamish Kidd b,
Gordon Johnstone c and Stephanie Allan a
* Chair, Early Intervention in Psychosis Lived Experience Reference Group
a Institute of Health and Wellbeing, University of Glasgow
b Support in Mind Scotland
c Bipolar Scotland & Voices of eXperience (VOX)
In March this year Healthcare Improvement Scotland produced a summary report on early intervention in psychosis for the Scottish Government. The report was co-produced with people with lived experience, their families and carers. We asked Dr. Louise Beattie, chair of the Lived Experience Reference Group and colleagues to discuss how the recommendations in the report were identified and the next steps for early intervention service development in Scotland.
To date, a specialist early intervention in psychosis service has only been available in one of Scotland’s fourteen regional Health Board areas. This is despite early intervention in psychosis featuring within clinical guidelines since 2013.1,2
Policy makers are now taking positive steps to address this, and the voice of lived experience has been crucial to the design process. The Early Intervention in Psychosis Lived Experience Reference Group conducted engagement events, with an Engagement Worker commissioned by Healthcare Improvement Scotland (HIS) via Support in Mind Scotland.
We found that the current absence of early intervention in psychosis is incurring significant additional upset for individuals and families in Scotland. Here, we summarise what we did, what we found, and outline our next steps to towards adoption of early intervention in psychosis approaches throughout Scotland.
The devolved Scottish Government included the propagation of early intervention in psychosis as an action within its Mental Health Strategy, 2017-2017. 3 HIS, a national improvement body, led work to report on how this could be done, working in partnership with a new Early Intervention in Psychosis Lived Experience Reference Group, of which we are members. We conducted engagement events and prepared a detailed report based upon what individuals affected by psychosis told us. 4
Across accounts, the importance of intervening early was apparent and there was a clear consensus about the need for far greater support when first episode psychosis occurs. Early intervention was viewed positively and individuals who took part were keen to further develop this agenda and contribute their voice for change.
We identified four key recommendations from our work:
- Public awareness of psychosis needs to be raised and the associated stigma and discrimination addressed.
- Family members, partners and supporters of people with first-episode psychosis need to be identified quickly and worked with pro-actively by services.
- People who experience first episode psychosis need person-centred care delivered by a well-coordinated partnership of statutory and third sector organisations, including hearing voices groups.
- A human rights based approach should be at the heart of the design, implementation and delivery of services for people with first-episode psychosis.
Our recommendations informed the final report created by HIS.5 HIS spoke to all fourteen Health Boards within Scotland, and found patchy adoption of key elements of early intervention, generally delivered by generic Community Mental Health Teams (CMHT). Without ring-fenced funding, Boards reported that it would be difficult to implement specialist early intervention in psychosis approaches. A further challenge relates to the socio-geographic nature of Scotland, and how to deliver early intervention services in rural areas with low population density.
Specialist standalone, hub and spoke and augmented CMHT were identified as current service delivery models from the literature, with varying levels of associated evidence.
These reports are currently with the relevant Minister awaiting a decision.6 As we move into a Parliamentary Election, those with lived experience are still not experiencing early intervention. Regardless of any political change, the needs of individuals and families who experience psychosis must be central to plans for future service delivery.
Louise is a Medical Research Scotland Daphne Jackson Fellow looking at sleep and emotion in early psychosis. She is also employed by the NRS Mental Health Network. You can follow Louise on Twitter @BeattieL
Hamish works for Support in Mind Scotland as an engagement project worker (lived experience) for the Early Intervention in Psychosis project. You can follow Hamish on Twitter @HamishKidd1
Gordon is an independent consultant and peer researcher. He is Chair of Bipolar Scotland, a Director of Voices of eXperience (VOX) and a Public Partner with Healthcare Improvement Scotland. You can follow Gordon on Twitter @GordonAJohnston