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Rotherham 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?

One 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.

2 | Rotherham Early Intervention Team

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.

www.rdash.nhs.uk | 3

• 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 you.


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.

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.

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.

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


Referral directly to Early Intervention i.e. family, school, college etc.

No indication of psychosis

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.

Referral and Assessment Pathway

First Episode Psychosis

At Risk Mental State

Identified need for extended assessment

Max six months

Referral from Single Point of Access

Discussed in Multi-disciplinary

Team

Assessment by Early Intervention

Team

Signposted to relevant service


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 psychologists and psychiatrists. The whole

team works together with the person to achieve their recovery.

Published by NHS England8 | Rotherham Early Intervention Team

The Recovery Ethos

The Rotherham 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

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 consists of medical treatment such as

medication, psychological treatments such Cognitive Behaviour

Therapy (CBT), group, 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 assist to measure the process people are making

toward Recovery.

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. The cost of

not intervening early, prolonging the time that people experience a

psychosis without treatment, duration of Untreated Psychosis (DUP)

results in poor health outcomes and lengthy treatment of mental

health services.

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.

NIHCE recommended treatments available from the Early

Intervention in Psychosis Team include:

• Cognitive Behaviour Therapy for Psychosis (CBTp)

• Family interventions (FI)

• Medication

• Physical Health Assessments and healthy lifestyle promotion

• Physical health interventions

• Educational and employment support

• Carer focused education and support.

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

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.


Outcome measures

Two outcome measures are routinely used with the Early

Intervention Team in Rotherham.

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. 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’

The Process of Recovery Questionnaire (QPR) is a self-rated

questionnaire completed by the service user.

Anonymous outcome data is shared with NHS England as part of

routine national data collection.

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 to five years.

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 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.

• 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.


Tell us if you’ve got something to say?

We at the Rotherham 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 Rotherham Team Manager either by telephone or in

writing please do so:

Phil Goodwin

Team Manager, Early Intervention Team

Rotherham Doncaster and South Humber NHS Foundation Trust

Swallownest Court,

Aughton Road

Swallownest

Sheffield S26 4TH

Telephone: 01709 447446

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.ukwww.rdash.nhs.uk | 15

This information is correct at the time of publishing Last Reviewed: September 2017

geta p p r o v e d

DP8222/09.17

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