Today (Thursday 22nd September 2022), Minister for Mental Health and Older People, Mary Butler, T.D. launched the HSE’s National Clinical Programme for Early Intervention in Psychosis Independent Evaluation Report.
Carried out by TCD, the independent evaluation report, titled ‘A Process Evaluation of the Implementation of a new model of care in three demonstration sites’, is the first of its kind in Irish Mental Health Services. It sought to establish the experience of service users, families and staff as these new evidence-based Early Intervention in Psychosis teams were implemented in Ireland. It also aimed to establish the key facilitators and barriers to implementation of Early Intervention in Psychosis Teams in Ireland.
Mary Butler, T.D., Minister for State, Mental Health TD said: “I am delighted to launch the publication of this important evaluation of Early Intervention in Psychosis Mental Health Services, which was a key commitment under Sharing the Vision. Evaluation projects such as this are crucial to ensuring our resources are used effectively and efficiently in supporting people accessing mental health services and supports.
“I would like to recognise everyone who contributed to the development of this report, as well as all the staff who have worked tirelessly over the past number of years to provide Early Intervention in Psychosis Services. This report highlights that your hard work and commitment makes a real difference in people’s lives.
“I am confident this report will provide a blueprint on how to progress the future development of the National Clinical Programme for Early-Intervention in Psychosis, ensuring it best serves those in need of support.’’
Professor Catherine Darker, Associate Professor of Health Services Research, Discipline of Public Health and Primary Care, Trinity College Dublin said: “In 2019, we were commissioned to conduct a process evaluation. People can and do recover from psychosis. The speed in which a person can be identified as having their first episode of psychosis, be assessed and commenced in treatment matters. The three demonstration sites attempting to implement this new model of care for Early Intervention in Psychosis did very well overall. They demonstrated that they could, in the majority of cases, see service users within three working days, standardise assessment practices, and treatment interventions for those presenting to the services.
“In the instances where demonstration teams were slow starting up and had to implement a waiting list for a period of time, our findings suggest this was due to challenges in drawing down budget allocations due to derogation of funds and securing backfill for posts, which subsequently had a knock on effect on the ability of Clinical Leads to identify skilled staff to develop the teams in line with the Model of Care. We have identified solution-focused ways for the HSE to remedy these problems, so as that these much needed services, can be rolled out nationally without some of the teething issues identified in this evaluation.
“Despite these challenges, clinical teams remained optimistic that this Model of Care is the best way to treat patients in their areas. Most importantly, patients themselves receiving the service welcomed having an identified team member to organise their care, to avail of cognitive behavioural therapy specific to psychosis, family interventions and where sensible to look to return to education or work.”
Thanking Minister Butler for her support for the development and expansion of these EIP services, Dr. Karen O’Connor, National Clinical Lead and Consultant Psychiatrist RISE EIP team South LEE Cork added that this report evidences the value of this investment. “EIP works, people like it and it saves money”.
She urged the Minister to continue to support the full implementation of the programme so that all service users and families across Ireland get access to high-quality, evidence-based mental health service.
Dr O’Connor also highlighted the report’s findings on the role of the EIP key worker (new role). Each person attending an EIP team is linked to a dedicated EIP key worker for three years. The report found that having an EIP keyworker reduced the risk of disengagement and increased likelihood of people engaging with other evidence-based interventions like talking therapy, employment and family education and support. The report recommended that this new EIP keyworker role should be fully integrated into the health service.
Opening the event, Paul Reid, CEO HSE, acknowledged the need for early intervention, high quality, evidence-based services for young people with psychosis and their families to ensure a difference in personal recovery and clinical outcomes. In particular he acknowledged the service users and families who contributed to the evaluation recalling their experience of new services and guiding us as we plan the further roll out of EIP teams across the HSE in line with Sharing the Vision.
He spoke of the pioneering work of HSE mental health clinicians who persisted with the project during particularly challenging years of a pandemic and congratulated them on their success. He thanked Professor Catherine Darker and her team at TCD for the report which would guide the further implementation of EIP teams.
- Psychosis is a condition that affects the way the brain processes information. The person experiencing psychosis might see, hear or believe things that are not real. Those suffering with psychosis can experience a loss of touch with reality and develop symptoms such as hallucinations or delusions. Psychosis typically has its onset in an individual’s late teens or early twenties.
- There are typically long delays between people starting to experience symptoms and accessing mental health care (Average of 2 years delay). The longer the delay between onset of symptoms and accessing mental health care the worse the outcome. Usually, mental health care is accessed late and in crisis. In the absence of an Early Intervention in Psychosis service, access to evidence-based psychosocial interventions e.g. talking therapies, family intervention, employment support is limited.
- The Irish Early Intervention in Psychosis Clinical Programme published its Model of Care in May 2019. This Model of Care sets out a 3 year programme which addresses three key areas: 1. Reduce delays in accessing specialist care, 2. Increase access to the full range of evidence based interventions Medication, Cognitive Behavioural Therapy for psychosis, Behavioural Family Therapy, Individual Placement Support (Employment and Education support), Physical Health Monitoring and Support and Peer support, 3. Ensure assertive, patient centred, recovery oriented care. Each person with psychosis is assigned to an Early Intervention Psychosis Keyworker. The EIP keyworker and the EIP team works with them and their families for three years to instil hope and support each individual in their path of recovery. Supporting people to get back to education/ work and a meaningful life.
- 20 years of international data now demonstrates that Early Intervention in Psychosis Services improve service users outcomes, reduce relapses, reduce requirement for hospital admission at first presentation and later, reduce suicide rates and increase retention in education and work.
- Early Intervention in Psychosis is an ‘Invest to Save’ Clinical Programme. Each €1 invested in EIP results in €18 saving to the health service by reducing admissions, reducing relapses, reducing crisis presentations and increasing retention in employment and education.
- In 2018/ 2019, the Early Intervention in Psychosis (EIP) National Clinical Programme funded the development of 3 new evidence based EIP teams in Cork, South Lee, Sligo/Leitrim/South Donegal and Meath.
Last updated on: 22 / 09 / 2022