Currently, in both hospital and community settings, antipsychotic drugs are the primary treatment for psychosis and schizophrenia. There is well-established evidence for their efficacy in both treating acute psychotic episodes and preventing relapse over time in conjunction with psychological interventions.
However, despite this, considerable problems remain. A significant proportion of service users, up to 40 per cent, have a poor response to conventional antipsychotic drugs and continue to show moderate to severe psychotic symptoms (both positive and negative).
In the first quality statement, NICE recommends that adults with a first episode of psychosis start treatment in early intervention in psychosis services within 2 weeks of referral. This is important as early intervention in psychosis services can improve clinical outcomes, such as admission rates, symptoms and relapse for people with a first episode of psychosis.
The second statement highlights the importance of offering adults with psychosis or schizophrenia cognitive behavioural therapy for psychosis (CBTp). CBTp in conjunction with antipsychotic medication, or on its own if medication is declined, can improve outcomes such as psychotic symptoms. It should form part of a broad-based approach that combines different treatment options tailored to the needs of individual service users.
Assessing physical health
There are statements to ensure that adults with psychosis or schizophrenia have specific comprehensive physical health assessments, and are offered combined healthy eating and physical activity programmes, as well as help to stop smoking.
Adults with psychosis or schizophrenia are more likely to be smokers, be obese and have type 2 diabetes. These factors contribute to a life expectancy in adults with psychosis or schizophrenia that is 15–20 years lower than for the general population. Regular assessment of the physical health of adults with psychosis or schizophrenia and offering lifestyle-based interventions are important to help address this inequality.
Currently, just 5-15 per cent of people with schizophrenia are in employment and so NICE recommends that adults with psychosis or schizophrenia who wish to find or return to work are offered supported employment programmes. Unemployment can have a negative effect on the mental and physical health of adults with psychosis or schizophrenia.
The quality standard also includes statements that focus on providing family intervention therapy to family members of adults with psychosis or schizophrenia and the service user where appropriate, and offering carers education and support programmes.
Professor Gillian Leng, deputy chief executive and director of health and social care for NICE, said: “Psychosis and the specific diagnosis of schizophrenia are serious mental illnesses that have debilitating symptoms and can affect all aspects of a person’s life. Many people with severe mental illness will also suffer from additional health problems, like heart disease and diabetes, which can significantly affect how long they live. Other symptoms such as a lack of drive or social withdrawal, means they might also struggle to contribute to society.
“We are seeing improvements in mental health services but there is still some way to go before we can be sure that all people with psychosis and schizophrenia are getting high-quality care. There are certain areas such as offering health checks, providing access to psychological therapies and employment support, where we know more still needs to be done to drive improvements in care.
“With this new quality standard we want to highlight what health and social care services need to prioritise to make sure all people with psychosis and schizophrenia are getting the care they need and deserve.”