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Developing early intervention services in the NHS: a survey to guide workforce and training needs

Department of Psychiatry, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE

Eileen Joyce, Professor of Neuropsychiatry and Hon. Consultant Psychiatrist and Thomas R. E. Barnes, Professor of Clinical Psychiatry and Hon. Consultant Psychiatrist

Department of Psychiatry, Imperial College Faculty of Medicine, St Dunstan's Road, London W6 8RP

Declaration of interest

None.

AIMS AND METHOD

We conducted a questionnaire study to establish the incidence, specialist staff availability, treatment provision and socio-demographic profile of patients with first-episode psychosis referred to all adult and child and adolescent community mental health teams in south and west London.

RESULTS

All 39 teams completed the questionnaire, identifying 295 cases of first-episode psychosis (annual incidence 21/100 000/year) referred in the year 2000. Teams manage to engage most patients with first-episode psychosis. A total of 73% of cases of first-episode psychosis were on some form of Care Programme Approach. However, many teams did not have adequately trained staff to provide psychosocial interventions. Even where such staff were available, care was focused mainly on monitoring medication and risk assessment, with only half the teams providing psycho-educational programmes and only a quarter offering individual cognitive-behavioural therapy to those with first-episode psychosis.

CLINICAL IMPLICATIONS

Establishing early intervention services nationwide will require significant new resources, including specialist trained staff, which could prove difficult to provide in inner-city areas. Rather than a single, uniform service model, several models of early intervention services based on locally determined need might be more realistic and appropriate, and also allow research into their relative efficacy.

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