Case study summary
Worcestershire Early Intervention in Psychosis (EIP) service places a strong emphasis on carer support. The service is committed to providing families and friends with information about psychosis and support. A range of services are also provided to meet these needs, including family and carer support, behavioural family therapy and carer support groups. Service data indicates that 80% of service users had their families involved in their care.
Worcestershire EIP service comprises two teams covering North and South Worcestershire. There is also a project underway to recruit a number of peer support workers. This skill mix is in keeping with that recommended for delivery of NICE-recommended care. In addition to addressing the needs of people aged 14–35 with first episode psychosis, the service also offers a time-limited intervention to young people with an at risk mental state.
Worcestershire EIP service places a strong emphasis on carer support. The service is committed to providing families and friends with information about psychosis and support. A range of services are also provided to meet these needs, including family and carer support, behavioural family therapy and carer support groups. Service data indicates that from a sample of 102 service users 80.4% had their families involved in their care.
In line with offering a combined healthy eating and physical activity programme the service is also piloting the Supporting Health and Promoting Exercise (SHAPE) physical health intervention programme, which uses the expertise of nutritionists, exercise physiologists and health trainers. It is a structured and intensive 12-week course with follow-up over 12 months, which includes a group educational programme and individually tailored exercises sessions.
In order to meet the needs of young people under the age of 18, Worcestershire EIP service works in close liaison with Child and Adolescent Mental Health Services (CAMHS). For the under-16s, medical responsibility for this group lies with the CAMHS psychiatrist but EIP psychiatrists are able to discuss cases with CAMHS colleagues and provide advice on diagnosis and prescribing. EIP nurses, social workers, occupational therapists and clinical psychologists are able to liaise with CAMHS colleagues regarding therapeutic approaches and interventions that may be useful (but do not take responsibility for case management or care coordination for those under the age of 16.) Regarding 16–18 year olds with early psychosis, bipolar I disorder or an at risk mental state, following a period of assessment by the EIP service – and in close liaison with CAMHS colleagues – young people in this age group are able to make the transition from the care of CAMHS to the EIP service. If a specific piece of therapeutic work or assessment is ongoing then full transfer to EIP may be delayed and the transition more gradual. Medical responsibility will then be transferred from the CAMHS psychiatrist to the EIP psychiatrist. Any nursing, social work, occupational therapy or psychological interventions will then be provided by the EIP service and an EIP case manager will be allocated to the young person. The EIP case manager will act as care coordinator and the young person may be supported through the Care Programme Approach.
Training to ensure the provision of NICE-recommended care:
- All care coordinators are trained in and are delivering family intervention.
- Training is offered by the SHAPE physical health programme.
- Through training the service is also ensuring that there is adequate provision of CBT for psychosis and there are adequate numbers of staff to assess and monitor cardiometabolic health and to provide alternative educational and occupational activities.
Worcestershire county population, incidence and workforce for 16–64 year olds
|Location||Predicted cases (from finger tips data)||Incidence per 100,000 people aged 16-24|
|Worcestershire County – 363,450||Not reported||16.6|
|Bromsgrove – 59,231||10||16.4|
|Malvern Hill – 45,262||7||15.2|
|Redditch – 56,819||13||20.1|
|Worcester City – 66,783||14||20.6|
|Wychavon – 73,486||12||15.7|
|Wyre Forest – 61,889||10||16.6|
Service model: ‘Stand alone’ EIP service
Workforce: The service is multidisciplinary with a varied skill mix, including community mental health nurses, occupational therapists, social workers, nurses who are also non-medical prescribers, psychiatrists and clinical psychologists.
Provider: Worcestershire Health and Care NHS Trust