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The government has thrown its weight behind an ‘Early Psychosis Declaration’, originally called ‘The Newcastle Declaration’ – an international initiative to make the early diagnosis and treatment of psychosis a world-wide priority. As the name suggests, the Declaration grew out of a NIMHE conference in the north eastern English city of Newcastle. But its ripples are now being felt around the world. The International Early Psychosis Association (IEPA) heard a presentation on the Early Psychosis Declaration at its Vancouver meeting in Canada this autumn, where it also received full support from the World Health Organisation (WHO) via a filmed statement from Bernadetto Saraceno, Director of Mental Health with the WHO. It is to be the subject of further debate at the World Psychiatric Association conference in Florence this November. The International Early Psychosis Association (IEPA) is feeding the Declaration into its work on developing a set of international quality indicators for early intervention services. Here, the government’s formal backing gives the Declaration a central place in the reform of mental health services. There are continuing structural reforms – with early intervention teams being set up in 50 sites around England, but the declaration will do more. It sets the work of the teams within a broad international framework that recognises the value in improving outcomes for people with severe mental illness. More widely, it sets mental health care on an equal footing with physical health care where “early intervention” has long been recognised as making good medical sense and also every citizen’s right. Imagine breaking your leg or collapsing in the street with chest pains and being told that you would have to wait up to 18 months before having your leg set in plaster or receiving an ECG. Up until now, that has been the situation if you start hearing disturbing voices or experiencing feelings of paranoia. The declaration says that this is unacceptable; that people have every right to expect help early and that the help they receive should be delivered in a culture of hope, optimism and involvement. The long-stay back ward found in Victorian asylums has passed into history, in England at least. Unfortunately, the culture that sees people with long-term severe mental health problems as hopeless cases who are best managed by medication and repeated hospital admissions during periods of crisis lingers on. The Declaration says that another future is possible – one of recovery, holistic care and increasing independence, personal responsibility and social inclusion. Part of that holistic approach is engagement with local communities designed to break down the prejudice, ignorance and fear that can so often stand in the way of people seeking help early and in finding their place back in their communities. If your family and friends believe that everyone who has a “breakdown” is mad and stands outside the community, you are unlikely to talk over your emerging feelings of isolation, disturbed thoughts and fears. On the other hand, a society where there is at least some basic understanding that an individual’s mental health can be as fragile as their physical health and that acceptance is an important step on the road to recovery encourages people to speak out and seek help early. So what practical effect is the Early Psychosis Declaration likely to have in the next few years? We will be talking about the Declaration and promoting it at conferences throughout the rest of 2004 and into 2005. We are forging links with the Royal College of Psychiatrists and the Princess Royal Trust for Carers to develop early intervention materials for carers. We are working with Exeter University and the Welcome Foundation to promote early intervention through 120 performances of ‘On the Edge’, a play about early intervention aimed at young people. The performances will support a national competition to design a recovery pack for and by school-age young people. Within NIMHE we are targeting the regional development centres with a series of “hothouse” seminars that will bring together local ‘movers and shakers’ to identify the best ways to begin to put the Declaration into practice. By spring next year, every existing and planned early intervention team – 50 across the country – will be networked into a NIMHE Early Intervention ‘Knowledge Community’, sharing best practice and raising awareness of the Early Psychosis Declaration across health and social care services. From the evidence of the 37 early intervention teams already established, we expect there to be some radical differences between teams in size, resources, structure and outlook. We know that one-size will not fit all and that bringing in disadvantaged groups, particularly from black and minority ethnic groups, will be tackled in different ways within each team. But we do want to make sure that all the teams are supported and can grow together, learning from each other’s successes and occasional setbacks. It will not, for instance, be enough for a team to quickly engage with a large “case-load” and be so overwhelmed that it cannot engage with the local community in raising awareness and breaking down prejudice, ignorance and fear. Nor will it be enough to ensure that people quickly receive an appointment with a psychiatrist without they and their families receiving the information and support they need to make sense of what can be a frightening and disorientating experience. Equally, we will be keeping the pressure on the Government, Department of Health, NIMHE and other statutory agencies to make sure that resources follow the welcome commitment to the Early Psychosis Declaration. Capacity building – making the most efficient use of existing resources and bringing in new resources – is very much part of our remit. The network we are putting together can achieve an enormous amount over the next few months and years, but it requires one thing we cannot conjure up by ourselves – the active engagement of mental health practitioners from all fields, carers and most important of all existing and potential service users whose experience and involvement will be critical to the success of this early intervention programme.
Further information
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