To help EI teams adjust to the impact of the where to buy cialis now pandemic we have been gathering together policies, protocols and good practice that have been developed to support the maintenance of safe and effective services during the crisis. Please see the new COVID-19 section for national guidance and local example documents shared by EIP colleagues. We hope levitra without prescription overnight delivery this will help you adapt quickly to these new challenges and help you to provide the best care possible during this extraordinary period.

By Ann and David Shiers, 20th April 2020

Now in her 40s, our daughter enjoys life and is supported in an excellent residential care home. However she experiences severe psychological impairments, due to a combination of schizophrenia and learning disability. She requires support with all aspects of her life.

What if our daughter couldn’t complete her routine blood count? Maybe she’s had to self-isolate? Maybe the system had a temporary glitch? But whatever the cause, an absent ‘green’ blood test could result in our daughter’s clozapine being withheld.

Current product licensing rules. Because she has been on clozapine without evidence of suppressed white cell counts for more than 12 months then the current product licence permits a two-week extension. Beyond that, the prescribing doctor must take responsibility for prescribing outside the manufacturer’s product licence.

Are we reassured by the offer of blood sampling being taken in her residential home? NO! Would she accept a stranger in gown and mask coming to her home to take blood? It’s right OUTSIDE HER ROUTINE and she would almost certainly REFUSE.

Here’s what scares us. Vivid and painful memories of three years of incarceration in hospital following onset of psychosis in late teens. Drug after drug tried. Rock bottom. Nothing helped until clozapine was commenced. And now:
⦁ 23 years on clozapine without a single unsatisfactory routine blood test.
⦁ 23 years without a relapse of her psychosis
⦁ 23 years clawing back a life worth living

A balance of risks. Sacrificing 23 years of stability on clozapine and the horrendous risk of a relapse into hospital and then god knows what that might lead to in the longer term.  All because Covid-19 indirectly impeded routine blood testing.

Concerns from families like ours are being recognised. Take a look at the latest advice on clozapine from some notable national authorities:

⦁ Maudsley guidance on Covid-19 and clozapine

⦁ Rethink – Coronavirus and Clozapine

⦁ NHS Specialist Pharmacy Service – Clozapine monitoring during Covid-19

We shared our concerns with a psychiatrist friend. His view was “Where there’s a will there’s a way. With a flexible, collaborative and personalised approach involving patient, carers, clinicians & pharmacists I would be optimistic that this risk can be successfully navigated to ensure continuity of treatment”.

How does your service balance this clozapine and Covid-19 risk in these strange and worrying times?

POSTSCRIPT (May 11th): SEE CLOZAPINE PRESCRIBING RESOURCE

from Tees, Esk and Wear Valleys NHS Foundation Trust

These unprecedented times will put an inordinate strain on our services, which has led to the publication of helpful advice from NHS England on prioritising our mental health services. Of course it is vital to re-evaluate what is important and ensure that unnecessary activities are minimised in order to direct scarce staff resources to the point of greatest need.

For some time, EIP services were considered luxury services with high staffing levels, low caseloads and highly skilled practitioners. At times like this it may be tempting to think that EIP teams would be an easy place to look for staff to supplement other activities.

EI staff can certainly play their part in supporting the wider system during this crisis. They have skills in managing complex needs in the community, positive risk management and their physical health strengths can be called upon. However, it is important to recall the rationale for EIP. These teams were established to support some of the most vulnerable people within our mental health system. They provide the individual and their family with the most evidence based interventions to optimise recovery and minimise the chances of relapse and the associated difficulties that a relapse would bring.

• Psychosis and psychotic disorders can be extremely debilitating.
• People who do not access effective treatment quickly are far more likely to experience poor outcomes.
• People with psychosis are three times more likely to attend A&E and almost five times more likely to be admitted as an emergency

We know that a relapse from a psychotic illness has not only a profound impact on the individual but also the family and wider support system. A relapse could lead to the involvement of a wide number of health and social care staff as well as family and friends who may be affected by the impact of an acute psychotic episode.

Therefore, especially in the current climate, one of the most important things we could do in mental health would be to prevent relapse and thereby minimise this impact on family and friends and on the health, social care and criminal justice systems. EIP is one of the most evidenced systems of care to achieve this and as such should be prioritised alongside other essential services such as crisis teams.

Although it may be hard to sustain, it’s important to recognise that guidelines are clear on the interventions and approaches that achieve good outcomes, and the closer teams can remain aligned to these guidelines, the more likely they are to achieve them. EIP teams will need to focus on those with greatest need, utilise new technological strategies to deliver interventions and amend treatment protocols during the outbreak. But, similar to the daily reminder from our scientists about the best way to overcome the coronavirus, please remember the science and the evidence for what works.

From a mental health perspective, if we are to achieve social distancing, without increasing strain on crisis pathways, inpatient beds and the acute sector, EIP should be seen as a vital tool. It should not be considered a luxury that can’t be justified in difficult times, but a vital service model that needs to be prioritised and sustained.

Paul French