Case study summary
Working in partnership with service users and families necessitates positive risk taking and holding a holistic perspective of care, rather than being overly wedded to the medical model. Working closely together as a team to manage risk facilitates the approach to this challenge. Tower Hamlets Early Intervention Service (THEIS) provides high quality, skilled care and support to adults experiencing a first episode of psychosis and their families. The Tower Hamlets Early Detection Service (THEDS) is an innovative team working alongside THEIS to identify and support individuals who are at high risk of developing psychosis, in order to bring down duration of untreated psychoses in the borough, build resilience and prevent development of symptoms where possible.
Tower Hamlets Early Intervention Service (THEIS) provides high quality, skilled care and support to adults experiencing a first episode of psychosis and their families. The Tower Hamlets Early Detection Service (THEDS) is an innovative team working alongside THEIS to identify and support individuals who are at high risk of developing psychosis, in order to bring down duration of untreated psychoses in the borough, build resilience and prevent development of symptoms where possible.
The THEIS and THEDS team work closely together and constantly think of ways to support service users and their families to engage with the services and wider community resources to develop their coping skills and achieve their potential in one of the culturally most diverse boroughs in the country.
With a truly team based approach and a collective leadership model, they benefit from a wide range of disciplines, including nurses, doctors, psychologists, social workers, occupational therapists, a bilingual support worker and an employment specialist. Most staff are trained in delivery of Behavioural Family Interventions, as recommended in the NICE guidelines, and are able to offer family interventions to all clients and their loved ones. All clients are also offered NICE-compliant individual CBT for psychosis, as well as a number of therapeutic groups, which have the added benefit of shared experience communicated between service users, breaking down stigma and isolation.
Groups include social inclusion activity group, tree of life group, mindfulness group, making sense of psychosis and psychoeducation group, Couch to 5K group and acceptance and commitment therapy group. Monthly in-house training sessions are held, to learn from each other and share skill sets. Sub teams are responsible for driving innovations in various areas, such as links with the community, publications and information, service user and carer involvement and inter-team links for ensuring we are able to learn from other EI Services within the trust and further afield.
Close links have been formed with local third sector organisations including The Prince’s Trust, Look Ahead, Tower Hamlets Community Health Trainers, Rethink Family Action, and Urban Yogis. In particular, their employment specialist is currently deepening links with local colleges and training providers to increase service users’ access to training and job opportunities, and build relationships with local employers to enable young people to achieve their career goals and reach their full potential. They hold annual open days for third sector organisations and services users and their families, providing talks and stalls for information and refreshments.
They also have regular meetings with the local Child and Adolescent Mental Health Service team to ensure that transition to adult services for young people experiencing psychosis is as smooth and supportive as possible.
With 175 patients on the THEIS case load and 40 patients with the THEDS (at risk mental state) team, Tower Hamlets have met the national standard for two weeks referral to treatment for under 35s since April 2016 and over 35s since starting the pilot project in December 2016.
Commissioners have invested a further £280,000 to extend the service for the over 35yrs age group and they have employed 2.4 more psychologists and an extra care coordinator to support this. By operating a hub and spoke model, the over 35s remain within the community mental health teams with specialist EI input going in including psychology and care coordination. Thereby they maintain youth focus for the original under 35yr cohort of patients, believing this is important for the service users in terms of managing the difficult transitions in life required in early adulthood.
Around five current services users have completed interview panel training, provided by the trust people participation team, and they now have a service user sitting on all recruitment panels for the team- the service user is paid for their time. The trust team feel this is invaluable for recruiting quality staff. They have services users attending voluntary focus groups on improving the service. They also have other services users involved in various other individual things such as peer mentor, interviews for consultants to the trust, and service development meetings across the trust.
Examples of service developments following feedback include; ‘Couch to 5k’ running group set up to address requests for more support with exercise and physical health, and a specialist employment support worker recruited to address clients’ requests for more input in this area.
The THEIS team logo was designed by a previous service user. This year, they are planning to involve service users in redeveloping the team publication, and to follow up another suggestion from the focus groups by making some video testimonies of consenting service users and carers talking about their experiences, which can be shared with new clients to encourage insight and hope.
Challenges faced and how they have been overcome
Working in partnership with service users and families necessitates positive risk taking and holding a holistic perspective of care, rather than being overly wedded to the medical model. Working closely together as a team to manage risk facilitates the approach to this challenge.
Working with such a diverse population can present challenges for sharing the model of care, communication, engagement and social integration. THEIS and THEDS work collaboratively in dialogue with service users and carers about diverse models of understanding mental distress, so as best to integrate biopsychosocial understandings and care plans. They have several members of staff that speak more than one language and a specialist bilingual support worker to assist with verbal communication. Close relationships with the Tower Hamlets BME Access Service and Spiritual and Cultural Care Service facilitates awareness of particular culture-bound needs and preferences of groups who they work with.
They have had to identify and address the adaptions needed to implement therapeutic interventions such as baby friendly initiatives within different cultural contexts. Monthly multidisciplinary team meeting supervision around family interventions helps to facilitate these adaptations.
THEIS and THEDS are evaluated along performance indicators and CQUINS agreed between the trust and the clinical commissioners on a monthly basis. They are currently meeting the new standards set for referral to treatment time and NICE concordant care for all first episode psychosis patients in our service.
They undertake their own clinical audits of practice and have a number of staff trained in Quality Improvement with QI projects running on improving access and care planning. Service users deliver outcome feedback after all therapeutic groups and individual or family interventions. Experience feedback is sought on the inpatient wards and via their annual survey. They engage with the National Audit for Schizophrenia.
THEIS and THEDS share their work with others at regular trust wide Early Intervention meetings. They take a lead in organising and chairing the trust-wide Early Intervention Conference, in partnership with interested service users. Staff regularly attend London Early Intervention Network meetings, where they are able to share best practice, research ideas and service developments with other London teams. Members of staff attend national conferences as appropriate to specialties and professions, at which they are able to share learning more widely via posters and presentations. Regular team publication shares service developments, news and event plans with service users and their families, as well as including testimonies and creative writing from clients of the service.
Tower Hamlets Early Detection Service has improved engagement and timely support of young people at risk of developing psychosis by going into colleges, third sector youth organisations and faith groups to provide education around mental wellbeing, tackling stigma and encouraging referrals including self or carer referrals.
Sarah Dracass – Consultant Psychiatrist, talked about some recent feedback from a service users family: “He and his wife came for an appointment with me this morning…. They were saying how grateful they were for all the support that you and the rest of THEIS provided them. They said that he made great progress under the service and they have nothing but praise for the way THEIS helped him over the years.