PROMOTING RECOVERY IN EARLY PSYCHOSIS: A PRACTICE MANUAL
CONTENTS 1 INTRODUCTION, EI AND REFORM OF MENTAL HEALTH PRACTICE IN ENGLAND, EI: POLICY, PRACTICE AND RESEARCH, FINAL REFLECTIONS, USEFUL INFORMATION RESOURCES, REFERENCES, THEME 1 IMPROVE ACCESS AND ENGAGEMENT 2 DURATION OF UNTREATED PSYCHOSIS AND PATHWAYS TO CARE, KATERINE BRUNET AND MAX BIRCHWOOD INTRODUCTION, A BRIEF SUMMARY OF THE EVIDENCE, WHO EXPERIENCES LONG TREATMENT DELAYS?, BARRIERS TO IDENTIFICATION AND TREATMENT, IMPLEMENTATION INTO PRACTICE, EARLY DETECTION AND COMMUNITY EDUCATION, INTERVENTIONS IN PRIMARY CARE, INTERVENTIONS IN SECONDARY CARE, IMPLICATIONS AND CONCLUSIONS, 3 INPATIENT PROVISION IN EARLY PSYCHOSIS, INTRODUCTION, WHY HOSPITALISE?, PROBLEMS IN THE ACUTE WARD ENVIRONMENT, IMPROVING THE INPATIENT EXPERIENCE, IMPLICATION INTO PRACTICE, 4 DEVELOPING YOUTH-FOCUSED SERVICES, BACKGROUND, DEVELOPING YOUTH-FOCUSED SERVICES, WHAT DO YOUNG PEOPLE SAY ABOUT WHAT MAKES A GOOD SERVICE?, EXAMPLES OF DIFFERENT SERVICE MODELS, DESIGNATED SERVICE: COMPREHENSIVE MULTIDISCIPLINARY TEAMS, DESIGNATED TEAM WITHIN A SERVICE: THE ‘VIRTUAL TEAM’, DESIGNATED TEAM WITHIN A SERVICE: TEAMS BASED IN YOUTH SERVICES, DESIGNATED STAFF SECONDED TO ADULT TEAMS: LIAISON/LINK POSTS, HOW HAVE EI TEAMS DEVELOPED ACROSS ENGLAND TO TAKE ACCOUNT OF CHILDREN AND YOUNG PEOPLE UNDER 18?, SUMMARY, TOP TIPS FOR EI TEAMS TO SURVIVE AND GROW, 5 STRATEGIES FOR ENGAGEMENT, PRINCIPLES OF ENGAGEMENT, CHALLENGES TO ENGAGEMENT, IMPLEMENTATION INTO PRACTICE: PROMOTING ENGAGEMENT, CLINICAL CASE STUDIES: BUILDING POSITIVE PERSONAL RELATIONSHIPS, USEFULNESS OF SERVICE, REALISM, BEING SUPPORTIVE AND NON-JUDGEMENTAL, PACING, INDIVIDUAL APPROACH TO MAINTAINING CONTACT, NON-TRADITIONAL METHODS OF CONTACT, INCLUDING FAMILY AND FRIENDS, MEDICATION ENGAGEMENT, SERVICE ACCESSIBILITY, STAFF/PROFESSIONAL ISSUES, SUGGESTED FURTHER READING, USEFUL WEBSITES, 6 EARLY INTERVENTION SERVICE MODELS, CORE PRINCIPLES, A SUMMARY OF THE EVIDENCE, ESTABLISHING EARLY INTERVENTION TEAMS IN PRACTICE, MODELS OF SERVICE DELIVERY IN EIP, 7 COGNITIVE BEHAVIOURAL INTERVENTIONS IN EARLY INTERVENTION SERVICES, IMPLEMENTATION INTO PRACTICE: CASE STUDIES, A FIRST-EPISODE VOICES GROUP, WORKING WITH PEOPLE WITH FIRST-EPISODE PSYCHOSIS: SOME CHALLENGES AND SOME SOLUTIONS, BELIEFS ABOUT ILLNESS: CONSIDERATIONS FOR FORMULATION AND INTERVENTION, DESTIGMATISING AND NORMALISING DIFFICULTIES, TIME, FREQUENCY AND LOCATION OF SESSIONS, NEGATIVE SYMPTOMS AND COGNITIVE PROBLEMS, MAKING THERAPY FUN, 8 CULTURAL DIVERSITY IN EARLY PSYCHOSIS, INCIDENCE RATES, PATHWAYS TO CARE, REASONS FOR ETHNIC DIFFERENCES IN EARLY PSYCHOSIS, PROVISION OF CULTURALLY APPROPRIATE SERVICES, IMPLEMENTATIONS INTO PRACTICE, 9 ANTIPSYCHOTIC MEDICINES AND THEIR USE IN ? RST-EPISODE PSYCHOSIS, WHY IS MEDICATION BEING PRESCRIBED? ARE THERE ANY ALTERNATIVES?, WHAT MEDICATION IS BEING PRESCRIBED? ARE THERE ANY DIFFERENCES BETWEEN DRUGS?, WHAT DOSE IS BEING PRESCRIBED? I NEED IT TO WORK BUT WANT TO AVOID SIDE EFFECTS, WHAT IF MY MEDICATION DOESN’T HELP?, ARE ANY TESTS NEEDED BEFORE THE DRUG IS STARTED? WHAT ABOUT MONITORING?, WHAT IF A FEW DOSES ARE MISSED?, WHEN CAN I STOP TAKING THE TABLETS AND WHAT MIGHT HAPPEN? WILL I HAVE TO TAKE THEM AGAIN?, IMPLEMENTATION AND CONCLUSIONS, THEME 2 RAISING COMMUNITY AWARENESS 10 WORKING WITH DIAGNOSTIC UNCERTAINTY IN ? RST-EPISODE PSYCHOSIS, WHO WANTS A DIAGNOSIS? USEFUL SIGNPOSTS OR STIGMATISING LABELS?, DIFFERENTIAL DIAGNOSIS: THINGS WE SHOULD BE CERTAIN ABOUT, ORGANIC (PHYSICAL) CAUSES OF PSYCHOSIS, AFFECTIVE (MOOD) CAUSES OF PSYCHOSIS, TRAUMATIC CAUSES OF PSYCHOSIS, DEVELOPMENTAL DISORDERS AND PSYCHOSIS, STREET DRUGS, PERSONALITY AND PSYCHOSIS, DIAGNOSTIC STABILITY: DID WE GET IT RIGHT?, 11 EARLY DETECTION AND TREATMENT OPPORTUNITIES FOR PEOPLE AT HIGH RISK OF DEVELOPING PSYCHOSIS, 12 PRIMARY CARE LIAISON FOR INDIVIDUALS WITH ? RST-EPISODE PSYCHOSIS, DAVID SHIERS AND HELEN LESTER INTRODUCTION, OVERVIEW OF THE EVIDENCE, PRIMARY CARE AND THE PARADIGM OF EIP, CRITICAL PATHWAYS, DEVELOPING AN EDUCATIONAL STRATEGY, IMPLICATIONS FOR THE FUTURE AND CONCLUSIONS, USEFUL WEBSITE ADDRESSES, NOTES, 13 RAISING COMMUNITY AWARENESS FOR EARLY PSYCHOSIS, KATE MACDONALD AND PAUL BLACKBURN INTRODUCTION, THE EVIDENCE, 14 RAISING AWARENESS IN SCHOOLS, THE CONTEXT: HEALTH EDUCATION IN SCHOOLS, ON THE EDGE: AN INTERACTIVE TIE PROGRAMME ON FIRST EPISODE PSYCHOSIS, EVALUATION, THE CHALLENGES: PREPARATION, THE CHALLENGES: TOURING, OPPORTUNITIES, CONCLUSION, THEME 3 PROMOTING RECOVERY AND ORDINARY LIVES 15 WORKING WITH MOTIVATIONAL DIF? CULTIES IN ? RST-EPISODE PSYCHOSIS, NEGATIVE SYMPTOMS IN FEP: EVIDENCE SUMMARY, PREDICTIVE VALUE OF NEGATIVE SYMPTOMS IN FEP, INTERVENTION STUDIES, IMPLEMENTATION IN PRACTICE, ASSESSMENT, INTERVENTION, COMMON OBSTACLES, QUESTIONS FOR CLINICIANS, 16 EARLY INTERVENTION AND VOCATIONAL OPPORTUNITIES, EXAMPLES OF EARLY INTERVENTION SERVICES PROVIDING VOCATIONAL OPPORTUNITIES, 17 SUBSTANCE MISUSE IN ? RST-EPISODE PSYCHOSIS, PREVALENCE RATES IN DUAL DIAGNOSIS, EFFECTIVE INTERVENTIONS FOR DUALLY DIAGNOSED CLIENTS, DUAL DIAGNOSIS AND EARLY INTERVENTION, WHAT ARE THE PATTERNS OF DRUG USE IN THE UK?, WHY DO YOUNG PEOPLE TAKE DRUGS?, CANNABIS AND MENTAL HEALTH, DETECTING DRUG AND ALCOHOL USE, WHAT CAN WE DO?, 18 RELAPSE PREVENTION IN EARLY PSYCHOSIS, THE EVIDENCE BASE: RELAPSE PREVENTION AND EMOTIONAL RECOVERY, CBT FOR RELAPSE PREVENTION, EARLY SIGNS OF RELAPSE, THE PERSON IN RECOVERY, THWARTED RECOVERY, DEFENDED INDEPENDENCE, FREEDOM AND AUTONOMY, ROLE OF THE THERAPIST, THE SERVICE SYSTEM, 19 TRAUMA AND ? RST-EPISODE PSYCHOSIS, OVERVIEW: TRAUMA AND PSYCHOSIS, CAN EARLY TRAUMATIC LIFE EXPERIENCES CAUSE PSYCHOSIS IN ADULTHOOD?, CAN PSYCHOSIS AND ITS TREATMENT CAUSE SYMPTOMS OF PTSD? CAN EARLY ADVERSE EVENTS CAUSE VULNERABILITY TO SUBSEQUENT TRAUMA AND PSYCHOSIS?, INTERVENTIONS AIMED AT TREATING PTSD, CONCLUSIONS , 20 SUICIDE PREVENTION IN EARLY PSYCHOSIS, WHAT IS SUICIDE?, WHEN ARE PEOPLE MOST AT RISK OF COMMITTING SUICIDE IN FIRST-EPISODE PSYCHOSIS?, WHY DO SOME PEOPLE WITH PSYCHOSIS BECOME SUICIDAL?, WHO IS MOST AT RISK OF SUICIDE IN PSYCHOSIS?, HOW DO PEOPLE WITH PSYCHOSIS ATTEMPT SUICIDE?, ASSESSING SUICIDE RISK IN PATIENTS WITH FIRST-EPISODE PSYCHOSIS, HOW DOES ONE ASSESS SUICIDE RISK INITIALLY?, THE INITIAL RISK FORMULATION AND PROVISIONAL RISK MANAGEMENT PLAN, ADDITIONAL FACTORS TO CONSIDER DURING THE SUICIDE RISK ASSESSMENT, SUICIDE RISK ASSESSMENT SCHEDULES AS AN ADJUNCT TO ASSESSMENT, THE MANAGEMENT OF SUICIDE RISK IN PSYCHOSIS, ACUTE CONTAINMENT OF RISK, TACKLING THE CAUSES OF SUICIDALITY, TREATMENT CONSIDERATIONS IN PSYCHOSIS, SERVICE CONSIDERATIONS IN SUICIDE PREVENTION, THE FUTURE OF SUICIDE PREVENTION IN PSYCHOSIS, 21 MANAGING TREATMENT RESISTANCE IN ? RST-EPISODE PSYCHOSIS, ENGAGING WITH THE PARADOX: ENHANCING RECOVERY FOR PEOPLE WITH DELAYED RECOVERY, UNDERSTANDING AND INTERVENING IN DELAYED RECOVERY, LEARNING POINTS, SUGGESTED WEBSITES, 22 NURTURING HOPE IN EARLY PSYCHOSIS: A CONCEPTUAL MODEL TO GUIDE INTERVENTION, RESEARCH INTO THE SIGNIFICANCE OF HOPE AND HOPELESSNESS IN EARLY PSYCHOSIS, IMPLEMENTATION INTO PRACTICE – DEVELOPING AN INTEGRATIVE MODEL OF HOPE AND A BROAD APPROACH TO THE INSPIRATION AND NURTURING OF HOPE, IMPLICATIONS FOR CLINICAL PRACTICE: THE INSPIRATION OF HOPE IN THERAPY, CONCLUSIONS AND IMPLICATIONS, THEME 4 FAMILY ENGAGEMENT AND SUPPORT 23 FAMILY INTERVENTIONS FOR ? RST-EPISODE PSYCHOSIS, SUMMARY OF THE EVIDENCE, SERVICE EXAMPLES, THE CONTENT OF FI WITH FEP, TRAINING IMPLICATIONS, 24 SHARING CARE WITH FAMILIES, GATHERING INFORMATION FROM FAMILIES AS PART OF THE INITIAL ASSESSMENT, CONFIDENTIALITY, THE CONCEPT OF ENGAGEMENT WITH CARERS, INVOLVEMENT IN CARE PLANNING, EARLY WARNING SIGNS AND CONTINGENCY PLANNING, RECOVERY FOR CARERS, 25 THE NEEDS OF SIBLINGS IN ? RST-EPISODE PSYCHOSIS, EVIDENCE SUMMARY, NUMBERS OF SIBLINGS COPING WITH FEP, IMPACT OF PSYCHOSIS ON SIBLINGS, SPECIFIC ISSUES FOR SIBLINGS, SIBLING ENGAGEMENT, SERVICE EXAMPLE, INFORMATION BOOKLETS, 26 GROUP-BASED INTERVENTIONS, NORMALISATION AND RATIONALE, SETTING UP THE GROUP, THE PROGRAMMES, LEADERSHIP OF THE GROUPS, MAXIMISING THERAPEUTIC GAINS IN THE GROUP, ASSESSMENTS AND EVALUATION, PEER SUPPORT AND INVOLVEMENT IN SERVICE DELIVERY, ISSUES FOR CONSIDERATION/LESSONS LEARNT/ OBSTACLES ENCOUNTERED, THEME 5 PRACTITIONER LEARNING 27 ROLES OF DIFFERENT PROFESSIONALS, WHAT DOES THE NSF POLICY GUIDANCE HAS TO SAY ABOUT EIP SERVICE AIMS?, ‘TEAM WORKING’ – WHAT HELPS AND WHAT HINDERS?, HOW DO TEAMS EMBRACE RECOVERY PRACTICE?, NEW WAYS OF WORKING, CRIMINAL JUSTICE LIAISON TEAM, EDUCATION, REFERENCES 28 SHARED CAPABILITIES IN MENTAL HEALTH PRACTICE, BRIEF SUMMARY OF THE EVIDENCE, CASE STUDIES/NARRATIVE, PERSONAL DEVELOPMENT AND LEARNING, CHALLENGING INEQUALITY, PRACTISING ETHICALLY, RESPECTING DIVERSITY, WORKING IN PARTNERSHIP, PROMOTING RECOVERY, PROVIDING PERSON-CENTRED CARE, IDENTIFYING PEOPLE’S NEEDS AND STRENGTHS, 29 TRAINING CLINICIANS WORKING IN EARLY INTERVENTION, EARLY PSYCHOSIS DECLARATION, DEVELOPMENT OF THE EI TRAINING CD-ROM, DELIVERY OF THE FINISHED PRODUCT, USING THE TRAINING MATERIAL, FUTURE POSSIBILITIES, 30 CLINICAL SUPERVISION IN EARLY INTERVENTION TEAMS, INTRODUCTION: WHY CLINICAL SUPERVISION MIGHT BE HELPFUL IN EARLY INTERVENTION TEAMS, DEFINING CLINICAL SUPERVISION, COMMON FEATURES OF SUPERVISION, EVIDENCE FOR EFFECTIVENESS, TOO MUCH OF A GOOD THING?, ‘FIGURE IN LANDSCAPE’ – THE ‘HELICOPTER VIEW, STAFF DEVELOPMENT, THE ROLE OF GROUP SUPERVISION, EVALUATING SUPERVISION ARRANGEMENTS, 31 CONCLUSION: WHERE NEXT FOR EARLY INTERVENTION,