Doncaster Early Intervention Team · The Doncaster Early Intervention Team promote recovery based...
Transcript of Doncaster Early Intervention Team · The Doncaster Early Intervention Team promote recovery based...
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Doncaster Early Intervention Team
Information for service users and carers
Most people who come into contact with mental health services for
the first time will feel apprehensive. Although one in four people
will experience mental ill-health in their life time for most this may
be their first direct experience of mental illness or mental health
services.
Early intervention teams support, treat and work with people aged
over 14, who may be experiencing a first episode of psychosis.
What is Psychosis?
As many as three in 100 people will develop a psychotic illness in
their life and for the majority this will start between the ages of
15 and 30.
Everyone experiences times when they feel stressed, confused
or very upset; this is a normal response to difficult events and
situations. Feeling any of these things is not necessarily a sign
of mental illness, simply life events that we all face. However,
sometimes these feelings can last for a long time and begin to have
an impact on your life.
There is a lot of misunderstanding about what psychosis actually
means. It’s often mistaken to mean that a person is dangerous. The
way that the media portray psychosis can sometimes be unhelpful.
There is no suggestion that people with psychosis are any more
dangerous than anyone else. Sometimes people with psychosis may
respond angrily but this is usually due to fear or frustration just the
same as anyone else may react, it is not a sign of psychosis.
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First Episode Psychosis is the term we use to describe people, who
may be experiencing a range of psychotic symptom for the first time
these may include:
• Seeing, hearing, smelling or feeling something that other people
aren’t experiencing.
• The most common experience that people have is hearing voices
that other people don’t hear. This can be very frightening and
can make you believe that you are being watched or picked on.
• You may think that there is a plot to harm you and feel worried
or suspicious about other people.
• You may believe that you are getting personal messages from
the TV or radio.
• You may feel that you have special powers.
• You may feel like you cannot think straight. Your ideas may seem
jumbled, but it is more than simply being muddled or confused.
Other people might find it very difficult to follow what you say.
• You may feel worried that other people can read or hear your
thoughts.
With a psychotic illness, you will often experience very unusual and
sometimes unpleasant thoughts and experiences. They may appear
suddenly or they can also creep up so gradually that only people like
your close family and friends notice that you are behaving oddly or
differently. They may make you feel very frightened and sometimes
you may feel ashamed, scared or embarrassed that you do not want
to talk about these experiences.
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Having these strange thoughts and experiences can affect you at school,
work, home or social life. You may find it difficult to concentrate and
enjoy your usual activities. Your sleep and appetite may also be poor.
At Risk Mental States (ARMS) is the term we use to describe people
who may experience a relatively long period of less severe symptoms or
experienced a very short period of psychotic symptoms or an extended
period of poor social and cognitive (the way people think) functioning,
social isolation or withdrawal friends, family, study or employment.
Sometimes people referred to the Early Intervention Team are taken on
for an extended period of assessment. This might happen where the initial
assessments are inconclusive or the clinical picture is complicated by other
factors, for example substance misuse.
Psychotic episodes can occur after a stressful life event, such as losing a
close friend or relative. It can also be the result of a physical illness (such
as a severe infection) or the use of illicit drugs. Sometimes it is difficult
to know what has caused psychosis. This is where the Early Intervention
Team comes in. Your GP may have referred you to us or a concerned
member of your family may have contacted us, you may have spoken to
us yourself or your college, school or university may have called us. We
will spend a period of time getting to know you and finding out about
your experiences, we call this a comprehensive assessment. During this
assessment we will try to understand your experiences and decide with
you, the best course of treatment, care or support.
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Effect on families and friends
Family and friends (often called carers) may be the first people to
notice that something is wrong when a person experiences a mental
illness. They may feel confused and uncertain about why it has
happened, and may question themselves or the person’s childhood
experiences.
As a team we offer support to family and friends. This is called
Family Intervention (FI). We provide information and education about
psychosis and recovery. We also support carers in looking after their
own health and wellbeing. The idea is to help others understand
what is happening to their friend or relative and explore ways in
which they can help them. The team also uses the Triangle of Care
which brings together carers, service users and professionals with
the aim of promoting safety and recovery for people experiencing
mental health problems.
Keeping mentally well
There are things that we can all do to improve our mental health.
Look after yourself
This can mean trying your best to:
• Get a good night’s sleep – whenever you can, we have an
information booklet that can help people to improve their sleep,
we call this sleep hygiene.
• Eat right – try and eat as healthily as you can, we have lots of
information on healthy eating.
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• Drink sensibly – try and avoid too much alcohol or caffeine
(these can add to stress or low mood).
• Exercise, even a short walk around your neighbourhood will be
beneficial.
Be kind to yourself
Think how you would treat a friend if they were having a tough time:
• Be patient and understanding towards yourself, try and give
yourself a break sometimes, don’t be over critical of yourself or
kick yourself too hard.
• Try and do at least one thing you enjoy every day
• Try and make time for yourself to relax, we use relaxation and
mindfulness techniques as a key part of treatment.
• Instead of being critical of yourself, tell yourself what you or
others like about you.
Stay in touch with people
Lots of people enjoy time to themselves, however stress can make
people withdraw from others completely, which can sometimes
make them feel lonelier and more worried.
• Try and contact one person a day – it’s easy to spend whole days
or weeks without speaking to anyone
• Try and go out of the house even just once a day – this can make
you feel more connected and be a good distraction
• Try to keep talking to people you care about and who care about
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Family and Friends are important
Family or friends can help by encouraging the person to seek
support.
Unusual thoughts and behaviour can be difficult aspects of mental
illness for family and friends to understand and cope with. They may
feel shocked, confused or frightened. The most helpful thing is to try
and remain calm and supportive. A safe and comforting environment
can also be reassuring for the person.
What does the Early Intervention Team do?
We work with people in lots of different ways. This might involve helping
to try and make sense of what is happening, medication, individual
or family therapy, support with education or employment or finances,
physical or group activity. We aim to see people as quickly as possible
and give help that is specifically tailored to each person and work
closely with people and their families. We know that the quicker that
psychosis is treated, the better the prognosis or recovery is likely to be.
Psychotic experiences often happen at a critical development stage in a
young person’s life and so by getting help early the disruption caused by
psychosis can be significantly lessened.
Early Intervention Teams are made up of a range of staff from
lots of different areas including administration and secretarial
staff, community psychiatric nurses, occupational therapists, social
workers, support workers, health and wellbeing practitioner, carers’
support, employment and support specialists, ognitive behaviour
therapy (CBT), psychologists and psychiatrists. The whole team
works together with the person to achieve their recovery.
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The Recovery Ethos
The Doncaster Early Intervention Team promote recovery based
interventions in partnership with the service user.
Recovery in mental health is not defined the same as recovery might
be in other health care settings. Recovery starts from ‘a strength’
approach which means focusing on maintaining the independence
of the individual – concentrating on what they can do not what they
can’t do. It is optimistic in its outlook refusing to accept that people
will be dependent on mental health services, welfare benefits and
medication for the rest of their lives. The person is encouraged to
achieve their individual potential.
Within a recovery approach the team implement the Care
Programme Approach (CPA) which is a framework for supporting
and treating people experiencing a mental disorder whilst living
within their community. Each service user will have a comprehensive
health and social assessment of their needs, detailed risk assessment
Published by NHS England
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and individual care plan written in collaboration with their named
worker or care co-ordinator.
The Team Manager is responsible for maintaining clinical standards,
compliance with CPA and record keeping standards and this is
achieved by conducting data quality audits alongside clinical and
managerial supervision, team meeting and multi-disciplinary working
(MDT) arrangements.
Treatment Pathways
Following the assessment period an individual plan of care and
treatment will be discussed with and written in collaboration with
the service user which may consist of medical treatment such as
medication, psychological treatments such as Cognitive Behaviour
Therapy (CBT), therapy groups, social and health and wellbeing
interventions. The efficacy of planned care and treatment is
evaluated using a recognised evaluation tool the Process of Recovery
Questionnaire (QPR). The QPR measures the progress people are
making toward Recovery. The Health of the Nation Outcome Scale
(HoNOS) developed by the Royal College of Psychiatrists’ Research
Unit (CRU) the scale measures the health and social functioning of
people with severe mental illness.
Once an individual is assessed as experiencing a First Episode of
Psychosis or At Risk Mental Health State Early Intervention Teams
aim to start treatment quickly. There are several reasons for this.
There are significant personal, social and health impacts on the
individual when treatment is delayed or is not effective.
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In October 2014 NHS England published access and waiting time
standards for Early Intervention in Psychosis Services which requires
that more than 50% of people referred to Early Intervention teams
engage with the team within 14 days and more than 50% of people
experiencing first episode psychosis will be treated with a National
Institute of Health and Care Excellence (NIHCE) approved care
package within two weeks of referral. We routinely record data to
ensure this standard is maintained.
These access and waiting times are set to increase to at least 60%
by 2021. Doncaster EIT achieved 77% at the last audit.
NIHCE recommended treatments available from the Early
Intervention in Psychosis Team include:
• Cognitive Behaviour Therapy for Psychosis (CBTp)
• Family interventions (FI) we offer Behavioural Family Therapy (BFT)
• Medication
• Physical Health Assessments and healthy lifestyle promotion
• Physical health interventions
• Educational and employment support
• Carer focused education and support.
(separate leaflets are available with more detailed information about
these interventions).
Although the Early Intervention Team aim to prevent hospital
admission wherever possible, this is sometimes necessary. However if
service users require admission to an acute inpatient ward the team,
care coordinator or named professional will continue to remain
actively involved in the service user’s care, attending reviews on the
ward and planning discharge. All service users under the care of the
Early Intervention Team will be seen within seven days of discharge
from hospital.
Effective coordination of care
All service users will have a named care coordinator or lead
professional who will ensure that effective community care plans are
implemented under the standards of the Care Programme Approach
Framework (CPA).
Core principles of the Care Programme Approach are:
• Comprehensive multi-disciplinary assessment covering a range of
health and social care needs.
• Assessment of social care needs in accordance with the 2015
Care Act.
• Comprehensive formal written care plans including risk,
contingency and crisis planning. Service users will be offered a
copy of their individual care plan.
• On-going review and care plan evaluation at least once a year
although in reality this is likely to happen far more frequently
and will be evaluated as an individual’s needs change or when
elements of the care plan are achieved.
• On-going support for carers (family and friends) either informally
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or within a formal structured framework will be offered
and carers will be informed of their right to receive a carer’s
assessment.
Compliance with Care Programme approach standards are
monitored in supervision by the team manager and are
supplemented by frequent audit of clinical records.
The initial aim was to provide a means of recording progress towards
the Health of the Nation target ‘to improve significantly the health
and social functioning of mentally ill people’
Discharge from the Early Intervention Team
Service users who are assessed as not experiencing psychosis at the
end of the assessment process with be discharged, signposted or
transferred to the appropriate service which may include primary or
secondary statutory services or voluntary, independent services.
Discharge will normally occur following three years of intervention
from the team. Occasionally some individuals require extended
periods of treatment due to complexity or relapse for example and
therefore treatment interventions may be extended.
The aim for the majority of service users is to be discharged back
to primary care services at the conclusion of treatment. However
some service users may need on-going specialist mental health
care in which case care will be transferred to a Community Mental
Health Team. To facilitate a seamless transfer ensuring consistency of
treatment transfers will be conducted within the Care Programme
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Approach Framework and arrangements will commence usually six
months prior to discharge from the Early Intervention team.
Occasionally service users chose not to engage with mental health
service and we respect anyone right to refuse health and social care
however prior to discharging anyone due to none engagement we
need to be confident that:
• They have the capacity (in accordance with the Mental Capacity
Act 2005) to refuse treatment.
• The individual service users risk assessment does not identify any
risk that are unacceptable, to take with respect to service user
choice, within a model of positive risk taking.
• Discharge is in accordance with the Trust Disengagement
policies.
Supervision
All staff members receive clinical and managerial supervision in
accordance with Trust policy which includes an annual Personal
Development Review. Supervision arrangements include:
• Individual supervision from the Team Manager/Leader
• Informal adhoc peer and team supervision
• Formal peer group supervision including daily clinical meetings
and weekly multi-disciplinary meetings
• Clinical supervision is offered from the psychologist or cognitive
behavioural psychotherapist.
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Tell us if you’ve got something to say?
We at the Doncaster Early Intervention Team pride ourselves on constantly
trying to improve the services that we provide and the experiences
that people have who come into contact with the team. We take all
compliments, comments and complaints seriously and use them to try and
improve what we do. If you would like to contact the Doncaster Team
Manager either by telephone or in writing please do so:
Nicola Abdy
Team Manager, Early Intervention Team Doncaster
Rotherham Doncaster and South Humber NHS Foundation Trust
Bungalow 3, St Catherines Close
Tickhill Road Site
Balby
Doncaster DN4 8QN
Telephone: 01302 798485
You can also contact the Patient Advice and Liaison Team (PALS) at:
Rotherham Doncaster and South Humber NHS Foundation Trust
Woodfield House
Tickhill Road Site
Tickhill Road
Balby
Doncaster DN4 8QN
Telephone ....................................................................................
Or online at http://www.rdash.nhs.uk
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©John Anderson
This information is correct at the time of publishing Last Reviewed: July 2018
geta p p r o v e d
DP8339/08.18
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