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Early intervention psychosis

NHS England is introducing a new access and waiting time standard aimed at people suspected of experiencing first episode psychosis that will come into effect from 1 April 2016.

This will require that more than 50% of people experiencing first episode psychosis commence a National Institute for Health and Care Excellence (NICE)-concordant package of care within 2 weeks of referral.

The HEE mandate commitment for 2015/16 is:

4.9. HEE will work across the system to ensure the workforce is available in sufficient numbers and possesses the requisite skills and training to deliver National Institute for Health and Care Excellence approved packages of care to more than 50% of individuals experiencing first episode psychosis within a maximum of two weeks

4.10. HEE will work with NHS England to understand any current shortfall in capacity and skills to deliver Cognitive Behavioural Therapy for psychosis and family interventions, to help ensure that a sufficient number of accredited training programmes are made available. HEE will explore further with NHS England any associated leadership training required to support the new psychological therapy training programmes so that they are translated into clinical practice.

EIP stands for early intervention in psychosis and EIP teams are specialist community mental health teams that treat individuals with a first episode of psychosis. As well as the new access and waiting time standards, from April 16 these services are being supported by an additional £30m to improve provision. To receive NICE concordant care, patients need access to two types of psychological therapies, CBT for psychosis and Family Intervention. The primary concern for HEE therefore is to commission training to increase capacity in teams to deliver these therapies. See our Mandate commitment to this in sections 4.5, 4.9 and 4.10.

The Department of Health are transferring £5 million to HEE so we can support providers to be able to deliver the increase in EIP delivery and services. The money will be received in late September and there is every expectation from DH this will spent within this financial year. 

Early intervention in psychosis specialist training

A new Early Intervention in Psychosis (EIP) access and waiting time standard has been introduced for Early Intervention (EI) teams across England. Health Education England (HEE) has supported the introduction of this new standard by procuring relevant specialist training nationally, to provide mental health trusts with access to the necessary training needed to meet the new national standard. HEE has also supported the four regional preparedness programmes to procure additional training locally for EI teams within their regions.

From 1 April 2016, more than 50 per cent of people experiencing first episode psychosis will begin a NICE-approved package of care within two weeks of referral.

To support the delivery of NICE recommended care, many EI teams required training in Family Interventions (FI) and Cognitive Behavioural Therapy for psychosis (CBTp). The HEE procurement process for FI and CBTp is complete and EI teams began accessing training from an approved list of providers from January 2016. 

There are eight NICE quality standards that relate to the EIP access and waiting time standard, covering a range pharmalogical, psychological, social, occupational and educational interventions.

Referral to early intervention in psychosis service
Cognitive Behavioural Therapy
Family Interventions
Treatment with Clozapine
Supported employment programmes
Assessing physical health
Promoting healthy eating, physical activity and smoking cessation
Carer-focused education and support.

All of the above provisions must also consider issues of equality, diversity and language. There are several NICE guidelines and recommendations that cover early intervention in psychosis services. Teams must be able to provide access to all NICE recommended care and interventions in order to meet the standard. Many EI teams require training in a mix of specialist skills in order to meet the NICE standards

While HEE has coordinated the training procurement for Family Interventions (FI) and Cognitive Behavioural Therapy for psychosis (CBTp), it is the responsibility of each mental health trust and EI team to understand their local skills gap and training requirements.

The National Collaboration Centre for Mental Health (NCCMH), with help from the national Expert Reference Group, has developed a workforce capacity calculator to help local providers and commissioners plan their joint workforce capacity needs. This calculator will provide you with indicative levels of skilled staff your EI team requires.

In October 2014, the government released the Achieving Better Access to Mental Health Services by 2020 report. This report shows what action the government is taking to provide better access to care in mental health services within the next year, including the introduction of national waiting time standards for the first time. Among the first set of standard is the new Early Intervention in Psychosis (EIP) access and waiting time standard:

By April 2016, more than 50 per cent of people experiencing first episode psychosis will begin a NICE-approved package of care within two weeks of referral.

Early intervention is critical to improving people’s immediate and long-term personal and clinical outcomes. The new EIP standard aims to not only reduce the time it takes for people to begin early intervention treatment, but also improve people’s access to EI services.

This new standard is “two-pronged” and both conditions must be met in order to meet the standard:

A maximum wait of two weeks from referral to treatment; and
Treatment delivered in accordance with NICE guidelines for psychosis and schizophrenia.

Many EI teams currently work with people aged 18-35, however this standard applies to all people aged 14-65 who are experiencing first episode psychosis. This means many EI teams are preparing to expand their services to all those aged 18-65. CAMHS services will generally continue to work with those under 18.

Due to the capacity of training providers and the value of procurement, CBT and FI training is being procured nationally to meet EU procurement regulations and provide consistency and quality across all regions.

HEE is procuring training to acquire the competencies required to provide NICE guidance specified Family Interventions (FI) and Cognitive Behavioural Therapy for psychosis (CBTp).

HEE has been working with the regional preparedness programmes to understand the local workforce needs and provide input into the national procurement.

A national workforce steering group has been set up, chaired by HEE and with representatives from the four regional programmes, to support a consistent and coordinated approach to workforce training needs.

Furthermore there are four regional EIP preparedness programmes across England that are working with local providers and CCGS to prepare for the new standard.