Quality statement 1: Referral to early intervention in psychosis services

Quality statement

Adults with a first episode of psychosis start treatment in early intervention in psychosis services within 2 weeks of referral.

Rationale

Early intervention in psychosis services can improve clinical outcomes, such as admission rates, symptoms and relapse, for people with a first episode of psychosis. They do this by providing a full range of evidence‑based treatment including pharmacological, psychological, social, occupation and educational interventions. Treatment from these services should be accessed as soon as possible to reduce the duration of untreated psychosis.

Quality measures

Structure

a) Evidence of local arrangements to ensure that early intervention in psychosis services are in place.

Data source: Local data collection

b) Evidence of local arrangements to ensure that local referral pathways are available for adults with a first episode of psychosis to start treatment in early intervention in psychosis services within 2 weeks of referral.

Data source: Local data collection

Process

Proportion of adults referred with a first episode of psychosis who receive treatment from early intervention in psychosis services within 2 weeks of referral.

Numerator – the number in the denominator who receive treatment from early intervention in psychosis services within 2 weeks.

Denominator – the number of adults referred with a first episode of psychosis.

Data source: Local data collection.

Outcome

a) Acute hospital admission rates.

Data source: Local data collection. National data are collected in the Health and Social Care Information Centre Mental health and learning disabilities data set.

b) Duration of untreated psychosis.

Data source: Local data collection. National data are collected in Health and Social Care Information Centre Mental health and learning disabilities data set.

What the quality statement means for service providers, health and social care practitioners, and commissioners.

Service providers (such as GPs, community health services, mental health services and drug and alcohol misuse services) ensure that systems and protocols are in place for people with a first episode of psychosis to be referred to mental health services and start treatment in an early intervention in psychosis services within 2 weeks of referral.

Health and social care practitioners are aware of local referral pathways for adults with a first episode of psychosis and ensure that they start treatment in an early intervention in psychosis services within 2 weeks of referral.

Commissioners (such as clinical commissioning groups, NHS England local area teams and local authorities) ensure that they commission early intervention in psychosis services and ensure that local referral pathways are in place for adults with a first episode of psychosis to start treatment in early intervention in psychosis services within 2 weeks of referral. This needs integrated commissioning.

What the quality statement means for patients, service users and carers

Adults with a first episode of psychosis start treatment within 2 weeks of being referred to an early intervention service. This service provides support and treatment to help people with symptoms of psychosis. Early treatment (within 2 weeks) in these services is often successful at treating symptoms and preventing symptoms from coming back, and helps to reduce the number of people who need to be admitted to hospital.

Source guidance

Definitions of terms used in this quality statement

Early intervention in psychosis services

Early intervention in psychosis services are multidisciplinary community mental health teams that assess and treat people with a first episode of psychosis without delay (within 2 weeks). They aim to provide a full range of pharmacological, psychological, social, occupation and educational interventions for people with psychosis.

Early intervention in psychosis services provide care for adults with a first episode of psychosis during the first 3 years of psychotic illness. However, this may be extended if the person has not made a stable recovery from psychosis or schizophrenia.

Services should also take into account the 'negative' symptoms of psychosis and schizophrenia (such as emotional apathy, lack of drive, poverty of speech, social withdrawal and self‑neglect), and ensure services are accessible for people with these symptoms. [Achieving better access to mental health service by 2020 (Department of Health), Psychosis and schizophrenia in adults (NICE guideline CG178) recommendations 1.3.1.2 and 1.3.1.3 and expert consensus]

Equality and diversity considerations

Early intervention in psychosis services should ensure that culturally appropriate psychological and psychosocial treatment is provided to people from diverse ethnic and cultural backgrounds ensuring they address cultural and ethnic differences in beliefs regarding biological, social and family influences on mental states.