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Wolverhampton Healthcare NHS Trust has secured funding to create and develop an Early Intervention Service (E/S), underway in April 2000. It has achieved this through collaboration between the Psychology Service and the Mental Health Directorate of the Trust, the Health Authority and Social Services. The process of securing funding for the EIS began in 1997 with a Clinical Psychologist, with previous experience of early intervention and psychological treatment of psychosis, initiating a training programme in psychosocial interventions with psychosis, open to mental health workers in both health and social services. By 1998, a significant number of community mental health team members and ward staff had been trained in psychosocial approaches for people with psychosis. This provided an impetus to change the structure of how mental health services could be delivered. Following this, a draft document proposing the development of an EIS was circulated to key stakeholders including trust managers, senior clinicians and social service managers. This resulted in a proposal for a ‘hub and spoke’ model being adapted The central ‘hub’ of the service will be located in the area of Wolverhampton with the highest incidence of emergent psychosis. Dedicated ‘spokes’ of the EIS will be located within the four Wolverhampton community mental health teams. This final proposal resulted in a successful bid for funds to launch the service. Wolverhampton Health Care NHS Trust provides an example of good practice in that it shows how mental health service providers can work together in a co-operative and creative way to develop an EIS tailored to meet the needs of local service users. Contact: Yvette Brown
We have just completed the preliminary evaluation of an Early Signs Self-Management Project with voluntary sector staff (report available on request). A series of seven training days have also taken place for professional staff in the statutory sector based on an Early Signs Self-Management Manual which was extensively piloted within the voluntary sector self-management project and in our two existing early signs clinics. This pack has now been published and provides a step by step framework for early signs monitoring and intervention. We have two existing early signs clinics covering three localities which have been running for three years and eighteen months respectively with two more coming on stream in the next few weeks and two further clinics planned in the remaining two localities by the end of this year. These clinics offer support to all individuals with a psychosis and will provide an important focus for relapse prevention work for first episode individuals. We are currently developing our support to carers with an ambitious Carers Strategy including training, information and developing a broad range of support to all carers including first episode families. We currently have a rolling programme of relatives information groups. a CESP initiative in the north of the county and a substantial number of staff trained in Behavioural Family Therapy which provide for the needs of families with psychosis including first episode families. We feel this will provide the basis for support for first episode individuals and families as we tentatively move towards an early intervention service locally. Last year we successfully completed a retrospective audit of all first episodes in the north and south of the County over the previous three year period. The audit aimed to identify the process by which young people with psychosis access Secondary Care services (Pathways to Care), the interface between Primary and Secondary Care, what services individuals received and their level of satisfaction with those services and the experience and opinions of carers about the services provided. The audit analysed the performance of Worcestershire against service indicators based on the IRIS Guidelines and the Rethink standards and described expected outcomes if the service were congruent with these and determined to what extent current services matched up and achieved fidelity with the IRIS model. The audit findings were not dissimilar with audits carried out elsewhere Worth Staffordshire and Sandwell) and showed mixed outcomes for all the various service indicators used. There were clear gaps and dissatisfactions in relation to engagement with services, information, experiences of treatment, crisis support arrangements and help with social and vocational roles and accommodation. Knowledge and involvement in care planning was inconsistent with many individuals unaware of who their key worker was and families not routinely involved in the care planning process. The audit raised a number of issues and important service implications and will be used as a starter point to inform the development of a more effective and consistent service response in Worcestershire for first episode individuals and their families. Contact: Dr Jo Smith
Walsall is currently in the process of setting up an early Intervention approach within a two year project to develop assessment and intervention standards and protocols linking with the Department of Health Policy Implementation Guide recommendations, National Service Framework and Regional IRIS guidelines. We have a Project Management team and steering group comprising Voluntary, Statutory, Service User, Youth Services and Social Service representation. We have undertaken a Baseline audit together with Service Users and Carers, and will be developing Primary Care training Initiatives, Secondary Care training in IRIS and Psychosocial Interventions. A CESP training programme for Carers begins in October together with our Rethink colleagues. We will be developing a care pathway for Psychosis to be ready Early 2002. Links with Walsall IRIS:- Rethink Archways Walsall 01922 627706
Sandwell Health Economy has recognised the value of Early Intervention by including it as part of its the spectrum of care within its redesigned mental health services. The Black Country Mental Health NHS Trust has identified a consultant psychiatrist working in Child and Adolescent services who wishes to be involved in this area. Planning is underway to create a Practitioner Lecture Post in Behavioural Family Therapy. Financial resources have been obtained to enable recruitment to begin. The long-term plan is for the individual to be part of an E.I team. CAMMS are developing a small multi-disciplinary cohort of staff skilled in Behavioural Family Therapy approaches. The Adult Service have identified a small modern 4 bed room unit within its Hallam Hospital as potentially the bed resources for a future Early Intervention Service. What is required now to speed up the process is the Department of Health specification procurement for Early Intervention services. With the document, the Trust and other committed individuals will begin by considering potential partnership arrangements with neighbours Dudley and Walsall to raise the combined population to the minimum of 1 million required to attracting funding for this service. The vision is for a strategic service with 3 local teams. Contact: Mr Ralph Hall Director of Nursing BCMHT
Staffordshire Health Authority have recently supported a 'pathways to care' audit of young people admitted to hospital with a first episode of psychosis over a one-year period. The young people, their family or friends, and professionals involved from the onset of psychotic symptoms have been interviewed to identify the nature of their route into mental health services. A multi-professional IRIS Development Group has examined the information collected to identify examples of good practice locally and make recommendations for future service delivery and staff training. The work alongside the IRIS regional guidelines has been disseminated to each of the six resource centre areas promoting further interest in devising an integrated early intervention approach. Recommendations from the group have been fed into each of the strategy groups developing projects based on the seven National Service framework standards to ensure that early intervention remains at the heart of service development.
@ease is the mental health resource for young people developed by Rethink. @ease is a website resource for all young people and especially those who may be stressed or worried about their thoughts and feelings. Rethink is building on it's awareness raising work in the UK student community, recognised as good practice in the National Service Framework for Mental Health 1999. You may be interested to know that Rethink assisted the Eastenders soap opera scriptwriters to develop the successful storyline around 'Joe Wickes'. @ease aims to raise awareness of mental health and illness, dispel stigma, and provide further sources of information and support. Our young service users have shaped the name, look and content of the website from the beginning and we welcome feedback from young people and health professionals.
Contact: James Wade
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