EARLY INTERVENTION

•Early intervention services work with you if you are experiencing a first episode of psychosis.
•Psychosis is a term used if you experience a break with reality. This can include having unusual beliefs or seeing or hearing things that other people do not.
•If you have psychosis and do not get help for a long time, you may have more episodes of psychosis in the future.
•Early intervention services have been set up so people can get help sooner and try to prevent these problems.
•An early intervention team will be made up of staff such as a psychiatrist, psychologist, community psychiatric nurses, social workers and support workers.
•Your GP can refer you to your local early intervention team. In some areas, you may be able to refer yourself or your friends or family could refer you.

Who is early intervention for?

Early intervention teams treat and support people who are experiencing psychosis for the first time.

Psychosis is a medical term. If you have psychosis, you might see or hear things, or hold unusual beliefs, that other people do not. It is not a condition in itself, but more a set of symptoms present in conditions such as
•schizophrenia
•bipolar disorder
•schizoaffective disorder

If you have symptoms of psychosis, medication (known as antipsychotics) and cognitive behavioural therapy (CBT) can help.

The National Institute for Health and Care Excellence (NICE) recommends that if you are experiencing psychosis for the first time, you should be offered early intervention services, no matter how old you are. You get support from an early intervention team for a limited amount of time. This is usually three years, but can be longer.

If you have psychosis and do not get treatment for a long time, you are more likely to develop longer-term problems. This can include becoming unwell again with more episodes of psychosis and also problems with your relationships or being able to work or study. Early intervention services were set up so that people could get help for psychosis earlier and to try and prevent these problems.

An early intervention team is made up of different professionals who provide treatment and support.

Psychiatrists

A psychiatrist is a doctor who specialises in mental illness. They can give a diagnosis for symptoms of a mental health condition and also manage treatment, such as medication.

Social workers

A mental health social worker can give expert, practical help with your social care needs. This might be help with housing problems, educational issues or through giving general support and advice.

Community psychiatric nurses (CPNs)

A CPN is a qualified mental health nurse who works outside of hospitals. They can support you with taking medication, offer encouragement and help you to manage your health while living in the community.

Psychologists

A psychologist is a trained professional who can offer psychological assessment and therapy for mental health problems. They may specialise in treating particular conditions or providing a particular sort of psychological therapy.

Occupational therapists

An occupational therapist helps you to overcome difficulties with everyday tasks. They aim to help people be as independent as possible.

Other early intervention team professionals

Other people will also make up the team such as managers, psychotherapists and administrators.

These people work together closely and have regular meetings to discuss the progress of the people they support. You might hear these meetings referred to as ‘multi-disciplinary meetings’.

Access

Usually you will need a referral to access the early intervention team. A referral is when your details are passed to another team or service so that they can make an appointment to see you. Early intervention teams accept referrals from GPs and other mental health teams in the community. Sometimes local early intervention teams will also accept self referrals or referrals from friends and family.

After you have been referred

In most cases, your details will be passed on and someone will contact you to arrange an initial assessment. This is sometimes called a screening assessment or triage assessment. Although it is unlikely you will meet with the whole team, this assessment may take place with one or two different workers over the course of a few sessions. This is so that the team can work with you to plan how they can best support you.

They will discuss how you are feeling and what affects this. They will also discuss what sort of support you already have. They will ask you questions and together you will decide how best to move forwards with your treatment and care. You might get help from the team as a whole or just one person. The assessment and planning process should aim to meet your needs and choices. It should not just focus on what professionals and services can offer. It should address what you want and what you are good at as well as what you need or find difficult.

Because of the health complications that psychosis can cause, NICE recommends that:
•When you start taking antipsychotic medication, you should have a full range of physical health checks, including weight, blood pressure and other blood tests. These checks should be repeated regularly.
•Mental health professionals are responsible for doing these checks for the first year of treatment. Responsibility may then pass to your GP.
•You should be offered a combined healthy eating and physical activity programme by your doctor or mental health team.

Confidentiality

The team should not normally discuss your care or give information about you to people outside of the team without getting your permission to do so. This includes family members or carers. The only person that they will contact is your GP who should still be involved with your care and will work alongside the early intervention team. You can find more information in our ‘Confidentiality’ section.

If the team thinks that you have complex needs that need ongoing support, then you might be placed under the Care Program Approach (CPA). This is the framework that coordinates some people’s mental health care.

If you are eligible for CPA, then you should receive a care plan and regular reviews. You should also get a care coordinator who will be responsible for overseeing your care and support. A care coordinator can be someone from a number of backgrounds such as a social worker or Community Psychiatric Nurse (CPN). The eligibility criteria for CPA can differ depending on the area where you live. However, even if you are assessed as not needing CPA, then you should still be able to receive support from secondary mental health services. You can find more information about CPA in our ‘Care Program Approach’ section.

DISCHARGE

You usually get help support from an early intervention team for up to three years, but this can vary and can be longer. After this time, if you still need support for your mental health, your early intervention team can refer you to your local Community Mental Health Team (CMHT).

If you do not need the support of the CMHT, then you will be referred back to your GP who will be responsible for your mental health care.

You may be discharged from your early intervention team earlier if you have improved and are able to manage without their support. If this happens, you will be discharged back to your GP. You may not agree with your early intervention team if they are thinking about discharging you early or have already discharged you. If this happens, you could consider some of the options in this section, such as making a formal complaint.

You may prefer to be seen by a male or female professional within the early intervention team. Although you can request this, this may not always be possible. This would depend on who is available at the time. However this does not mean that you can’t ask for it if you feel it would help you.

If you have a care coordinator, then this person will have an overall responsibility for organising and monitoring your care. This is the person who you will probably have the most contact with. It is important that if you have a preference for a male or female care coordinator, the team consider this so you can build up a trusting relationship with him or her. If you have any cultural or religious needs, the team should also consider these.

Whether you are getting support from the whole team or only from particular people within the team, you should feel comfortable enough to discuss any issues that arise with them if you feel that there are any problems.

If you feel unhappy with how your care is being handled, then you could contact the Patient Advice and Liaison Service (PALS), who can try to resolve any problems or questions you have. Their details should be available to you through the early intervention team, but you can also find your local office details through this website.

If you are unhappy with your support then the help of an advocate can be useful. An advocate can help you to understand the mental health system and help you to be fully involved in decisions about your care. An advocate is independent from mental health services and can help to make your voice heard with problems you may come across. They may be able to help with writing letters for you or attending appointments or meetings.

There may be a local advocacy service in your area which you can contact for support. You can search online for a local service. You can find more information on advocacy in our ‘Advocacy’ section.

You could make a formal complaint if you are unhappy with your care from the early intervention team. If you wish to put in a complaint about the team then the Patient Advice and Liaison Service (PALS) at your local Trust could advise you on this. You can also get help with this from the Independent Complaint Advocacy Service (ICAS) who deal specifically with NHS complaints. You can find more information about complaining in our ‘Complaining about the NHS or Social Services’ section.

What about confidentiality?

CARERS

If you are worried about someone’s mental health then you might be able to contact the local early intervention team and ask for a referral. Sometimes this can only be done after someone has visited their GP first.

Care should be involved with decisions about care planning. There are particular rules regarding confidentiality and care. Unless a person consents, confidential information about them cannot be passed on to others, including family members, friends and care. The team should seek permission and ask the person about what they are happy for others to know. This would also include any care plans that are drawn up. You can find more information in our ‘Confidentiality and Information Sharing – For Care, Friends and Relatives’ section.

As a care, friend or relative of someone living with mental illness, you might find that you also need support. If you feel you need additional support to care for your loved one you could ask for a care assessment. You can find more information in our ‘Care Assessments’ section. Our section ‘Supporting someone with a mental illness’ may also be useful.