The health secretary’s announcement that the restoration of mental health services is to be prioritised post lockdown is very welcome and Simon Steven’s letter to the NHS has highlighted the importance of proactively supporting mental health service best price propecia users and the need to prepare for an increase in demand as a consequence of the pandemic. Boris has told us to get on our bikes and get back to work, and the shops and pubs are re-opening, but not surprisingly, after weeks of being told that going out of our houses generic levitra prices would lead to almost certain death, there has been some reluctance to return immediately to work and behaviours that risk transmission of the virus. Like teachers, front line mental health workers will need a lot of support to fully re-commence generic propecia mastercard direct care and interventions given current levels of health anxiety.

After months of lockdown, during which specialist care and treatment for people with first episode psychosis (FEP) has been unavoidably curtailed, the impact is starting to be seen.  Whilst few specialist Early Intervention in Psychosis (EIP) teams have been pooled into generic community teams as feared, most have been sharing staff with inpatient wards and other vital teams, attempting to deliver care remotely and preparing for worst case scenarios.  Therapies that online generic cialis 100 mg require face-to-face contact have been impacted and physical health checks paused. Teams have endeavoured to support relapsing patients, using PPE for community visits, but the regular and persistent contact that typifies the EIP approach has been significantly reduced. Many report getting less referrals from primary care, doing fewer new assessments and seeing more people coming through acute pathways, including hospital admissions.

EIP teams have naturally needed to focus on those with greatest need at the height of the pandemic but, as things stabilise, our ambition should be rapid and complete restoration of the full model. After years of developing and implementing new standards of care for people with FEP – standards of care based on strong evidence for effectiveness and recovery from this serious illness – we know how important what we do is. But we will need innovative and creative strategies and a safe, well supported workforce to reinstate all of the components of the approach.  

During the outbreak we have quickly learned how to deliver interventions remotely and have amended treatment protocols for new ways of working; successfully utilising new digital technologies and social media platforms. Some of this learning will become valuable new ways of working and has the potential to substantially improve efficiency in the future. But we also need to recognise that sometimes only face-to-face will do. New assessments, assertive engagement, initiating therapy and physical health checks can’t really be done on WhatsApp. In addition, we are recognising that inequalities in healthcare are a major factor during this pandemic. Not a new thing, but we need to be wary that we don’t contribute to those inequalities by providing access to care for only those people who are capable of and willing to engage in online interventions.

Performance management of the waiting time standard has been paused during the outbreak and contracting decisions are currently on hold, with planned service developments uncertain now in some places. It’s undecided whether this year’s national quality audit (NCAP) will go ahead as usual. Not surprisingly, many have expressed a desire to postpone or delay this autumn’s audit.

At the start of the outbreak, when we feared significant staff losses, this was a very understandable reaction. As we start to plan for our ‘new normal’ there remains concern that that the impact of the pandemic on the quality of our services will render the audit pointless.

Completing the audit takes many hours of work and critics have highlighted problems with narrow focus, inconsistent interpretation of the standards, gaming and long delays in publishing the results. Despite such shortcomings, however, we have for the first time a measure of quality that includes the first ever waiting time standard in mental health; that focuses on research based, NICE approved clinical interventions and that promotes the collection of outcome data.

Undoubtedly the audit will capture the impact of the pandemic this year, but continuing to do it sends out a strong message about EIPs commitment to quality and the need to continue to develop and improve our clinically effective, cost effective and morally grounded model, even in the hardest of times. Doing the audit this year sends out a powerful signal that Early Intervention in Psychosis remains an important priority for the NHS.

Recovery and restoration won’t be instant and there remains much to do and learn if we are to re-establish the entire EIP offer in a safe and sustainable way whilst this virus still threatens us. But postponing or diminishing this year’s audit would be a massive own goal – sending out the message that the quality of our services is some kind of first world luxury that ceases to matter in a crisis. The truth is that high quality mental healthcare will be more important than ever in the aftermath of the pandemic and for a treatment model that has been shown to be so effective, the sooner we can recover and restore the better.

The innovation and determination demonstrated by EIP teams during the outbreak means that people with first episode psychosis have been well supported despite all the limitations of the social distancing regime. The time has now come to raise our game back to pre-pandemic levels – and to brace ourselves to do the NCAP audit, whatever it shows.