Early intervention in psychosis: action plan

Annex B: Early Intervention in Psychosis - Case Studies

Case study 1: NHS Greater Glasgow and Clyde

ESTEEM (Glasgow) became operational in September 2002 providing an early intervention service for people with a first episode of psychosis within North Glasgow. Initial funding for the service was established through Modernising Mental Health. The Esteem team current staffing is 3.4 medical staff, 15.6 nursing staff, 3.7 AHP staff, 3.9 clinical psychology staff and 4.4 admin staff in 4 sub teams to cover all of Greater Glasgow and Clyde. Social work is provided by various HSCP social work area’s There has been a consistent accepted referral rate by Esteem of 100 people per annum. The current service caseload is around 200 people.

ESTEEM use an integrated care pathway (ICP) to guide assessment and treatment. This enables staff to deliver multidisciplinary care for those at highest risk of poor outcome. At the end of the 2 year engagement with the service people transition to community mental health teams or their general practitioner for continuing care.

The assessment process, linking to capacity and capability within the board, is one area of opportunity for future improvement work.

Case study 2: NHS Highland (Argyll and Bute)

NHS Highland (Argyll and Bute) does not have a specialist EI service for people experiencing psychosis but has identified action 26 as a priority. People are referred to and treated by existing Community Mental Health Teams (CMHTs) or CAMHS services depending on presenting age. The current referral rate ranges from 0 – 8 per annum across four localities. People are identified at referral based on the information providing by the referrer.

There is no defined pathway for people experiencing from psychosis to guide their treatment and determine input from health and social care professionals. Previous attempts to develop an ICP in NHS Highland did not produce a pathway. The approach taken is to try and ensure as many staff within the CMHTs have training to provide care. 36% of workforce have completed NES PSI training.

NHS Highland identified staff training and creation of a tailored patient journey pathway as areas for future improvement work.

Case study 3: Lived Experience

My experiences were really difficult for me to understand. I couldn’t make sense of what was happening. I couldn’t come up with a rational explanation, no one else ever has this going on, so I kept it to myself, never spoke about it, hid my behaviour as much as I could but things started to get really bad and my family realised my behaviour was irrational and convinced me to seek help and try talk to someone.

When I was in hospital I was convinced no one would understand or could help with what I was going through. When I spoke to the Doctors. I wasn’t fully honest; so nothing really happened, I wasn’t getting better, if anything I was getting worse. I then made the decision to try explaining everything that was happening and how I felt; I got in touch with a worker from Esteem. When she came out to see me I remember wondering what her reaction would be when I told her about what had been happening. I thought she would look at me as if I was crazy, and then phone someone to take me away. But when I was trying to explain thing’s it was very strange. She seemed to know that I was trying to say, as if she had heard something like this before. I was shocked yet she wasn’t. As we talked she was explaining stuff that was making me feel as if what was happening to me was an illness and that it could be treated. At last I had made some sense of it and this gave me hope.

My next step was to go with her to see a Doctor who started me on medication.
I wasn’t thrilled to be having to take pills daily but if it was to put me back on the road to recovery then it was a small sacrifice to make. Not only was I to take medication but esteem frequently came out to visit me. It was during these
visits I realised I had a psychosis and it was an illness. We talked at length on how it happened and why and what was going on in my head.

When on the medication and my understanding of what was happening improved, things changed dramatically. My head was clear the symptoms had all but a little gone it was the first time in years that I had felt like this. So much so I couldn’t remember when I last felt like this. I felt it was mainly down to the medication, which did have a few cons, like it gave me bad heartburn and indigestion and made me very tired when I took them but the pros of medicine by far out weighted the cons.

After a few months on the medication and with the support of my family and Esteem, my new support member from Esteem and I discussed staying well plans. What was happening and how to keep it from happening again. This was going really well, myself confidence went through the roof. I got a job working as a barman, something I never had the confidence to do before. My family noticed a huge change in me. I remember my mum talking to the Doctor and my mum was happy to explain the changes she saw in me.

Things were going so well now and I felt like a new person. I felt confident in myself and with the support of my family and my keyworker I asked about coming off the medication.

It had been over a year now and I knew I felt I could cope without them and the symptoms wouldn’t comeback, so gradually they were reduced slowly and then stopped.

Now that I have been off medication for a while I have a good job and a long-term relationship. I have things that give me a purpose and help keep me well and feel like I have a new life. The reason for this huge change I put down to these things:

Seeking help, medication, self determination to get better, support of family and friends and most importantly actually talking about what was going on. If I didn’t then the people from Esteem could not have helped or explain to me what was happening and that I wasn’t the only one this has happened to and I would not have got better.

I write about my experience in the hope that someone in the same horrible place I was back then reads this and it gives them the belief that things will change and what they are going through is not uncommon and it is treatable, I think it would have helped me.