Quality standard
Quality statement 1: Assessment for a first episode of psychosis
Quality statement 1: Assessment for a first episode of psychosis
Quality statement
Children and young people who are referred to a specialist mental health service with a first episode of psychosis start assessment within 2 weeks.
Rationale
Starting assessment for a first episode of psychosis within 2 weeks can improve outcomes by reducing the duration of untreated psychosis, as longer periods of untreated psychosis are linked to worse outcomes. Specialist mental health services can improve symptoms and clinical outcomes such as admission and relapse rates.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that systems are in place for children and young people who are referred to a specialist mental health service with a first episode of psychosis to start assessment within 2 weeks.
Data source: Local data collection.
Process
Proportion of children and young people who are referred to a specialist mental health service with a first episode of psychosis who start assessment within 2 weeks.
Numerator – the number in the denominator who start assessment within 2 weeks of referral.
Denominator – the number of children and young people who are referred to a specialist mental health service with a first episode of psychosis.
Data source: Local data collection. National data are collected in the NHS Digital Child and Adolescent Mental Health Services secondary uses data set with Mental Health Services Data Set (MHSDS).
Outcome
a) Mental health admission rates for children and young people.
Data source: Local data collection. National data are collected in the NHS Digital Child and Adolescent Mental Health Services secondary uses data set with Mental Health Services Data Set (MHSDS).
b) Duration of untreated psychosis.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (such as child and adolescent mental health services and early intervention in psychosis services) ensure that systems and protocols are in place for children and young people who are referred to a specialist mental health service with a first episode of psychosis to start assessment within 2 weeks.
Healthcare professionals (such as psychologists and psychiatrists) start assessment of children and young people who are referred with a first episode of psychosis within 2 weeks of referral.
Commissioners (such as clinical commissioning groups and NHS England) commission specialist mental health services that start assessment within 2 weeks for children and young people who are referred with a first episode of psychosis.
Children and young people who have been having hallucinations or delusions (believing things that aren't true) for 4 weeks or more for the first time start an assessment within 2 weeks of being referred to a specialist mental health service (such as a child and adolescent mental health service or an early intervention in psychosis service). These services find out why the child or young person is having hallucinations or delusions, and will provide support and treatment to prevent them from coming back. This will reduce the chance that the child or young person needs to be admitted to hospital.
Source guidance
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The 2‑week timeframe supports: Achieving better access to mental health service by 2020. Department of Health (2014)
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Psychosis and schizophrenia in children and young people: recognition and management. NICE guideline CG155 (2013, updated 2016), recommendation 1.3.1 (key priority for implementation).
Definitions of terms used in this quality statement
A first episode of psychosis
A first presentation of sustained psychotic symptoms (lasting 4 weeks or more). Symptoms may include 'positive symptoms' such as hallucinations (perception in the absence of any stimulus) and 'negative symptoms' such as emotional apathy, lack of drive, poverty of speech, social withdrawal and self‑neglect. [NICE's guideline on psychosis and schizophrenia in children and young people, recommendation 1.3.1 (key priority for implementation) and Introduction]
Specialist mental health service
An age‑appropriate multidisciplinary service such as a child and adolescent mental health service or an early intervention in psychosis service. [NICE's guideline on psychosis and schizophrenia in children and young people]