Elizabeth England

Development and implementation of early intervention services for young people with psychosis: case study.

BACKGROUND The development of early intervention services for young people with first-episode psychosis is a priority internationally. AIMS To evaluate the development, implementation and impact of existing and newly formed early intervention services in England. METHOD Multiple-case study involving staff, users, carers and commissioners of 14 early intervention services. RESULTS Service numbers increased in response to national policy directives. They were still actively working with 90.6% of service users 12 months after inception. They were highly valued by users and carers as providing a personal service that contrasted with previous experiences of care. Tensions between providing a quality service and meeting case-load targets linked to future funding led teams to adopt a series of survival strategies with some unintended consequences. CONCLUSIONS Early intervention services are highly valued by consumers and engage users effectively after 12 months. Implementation of these services is threatened unless sufficient consistent funding is made available.

Improving the management of dementia

Simple educational initiatives for primary care teams are not enough

Core outcome sets for use in effectiveness trials involving people with bipolar and schizophrenia in a community-based setting (PARTNERS2): study protocol for the development of two core outcome sets

BackgroundIn the general population the prevalence of bipolar and schizophrenia is 0.24% and 1.4% respectively. People with schizophrenia and bipolar disorder have a significantly reduced life expectancy, increased rates of unemployment and a fear of stigma leading to reduced self-confidence. A core outcome set is a standardised collection of items that should be reported in all controlled trials within a research area. There are currently no core outcome sets available for use in effectiveness trials involving bipolar or schizophrenia service users managed in a community setting.MethodsA three-step approach is to be used to concurrently develop two core outcome sets, one for bipolar and one for schizophrenia. First, a comprehensive list of outcomes will be compiled through qualitative research and systematic searching of trial databases. Focus groups and one-to-one interviews will be completed with service users, carers and healthcare professionals. Second, a Delphi study will be used to reduce the lists to a core set. The three-round Delphi study will ask service users to score the outcome list for relevance. In round two stakeholders will only see the results of their group, while in round three stakeholders will see the results of all stakeholder group by stakeholder group. Third, a consensus meeting with stakeholders will be used to confirm outcomes to be included in the core set. Following the development of the core set a systematic literature review of existing measures will allow recommendations for how the core outcomes should be measured and a stated preference survey will explore the strength of people’s preferences and estimate weights for the outcomes that comprise the core set.DiscussionA core outcome set represents the minimum measurement requirement for a research area. We aim to develop core outcome sets for use in research involving service users with schizophrenia or bipolar managed in a community setting. This will inform the wider PARTNERS2 study aims and objectives of developing an innovative primary care-based model of collaborative care for people with a diagnosis of bipolar or schizophrenia.

Survival after diagnosis of dementia in primary care

Is lower than in screened populations, so better education and training are needed

GP training in mental health needs urgent reform

Training has fallen behind in a rapidly changing healthcare landscape

The mental health of young people: the view from primary care

Children and young people’s (CYP) mental health services are the ‘Cinderella of the Cinderella services’ by being chronically underfunded and undervalued. Fifty per cent of mental illness begins prior to the age of 14 years and 75% by the age of 24 years.1,2 Although effective treatments are available, less than one-half of those who need such treatment receive it.1 Mental illness in CYP can have detrimental effects on educational, physical, and social development with enduring consequences into adulthood. Therefore it is crucial that CYP are able to access appropriate, welcoming, and effective mental health services when they need it. CYP who present to their GP are twice as likely to have a mental health problem, which may manifest as physical health complaints (headache, abdominal pain, and poor sleep).3 Within general practice there is an excess of oppositional defiant disorders seen in pre-school children and emotional disorders exceeding conduct disorders in school children and adolescents. Mental health illness in adolescent surgery attenders is linked with increased intensity and impairment of physical symptoms and increased exposure to illicit drugs.4 A 2016 survey of 302 GPs reported that 78% of GPs are seeing more CYP with mental illness and 61% are seeing more young people self-harming than 5 years ago.5 The No Health Without Mental Health report recognised that only a life course approach will allow us to successfully meet the mental health challenges of the future and emphasised the importance for the early years.6 The Future in Mind report highlights …

PARTNERS2: a protocol for the development of a core outcome set for use in mental health trials involving people with schizophrenia or bipolar disorder in a community setting

PARTNERS2: a protocol for the development of a core outcome set for use in mental health trials involving people with schizophrenia or bipolar disorder in a community setting Thomas Keeley, Humera Khan, Vanessa Pinfold, Paula Williamson, Jonathan Mathers, Linda Davies, Ruth Sayers, Elizabeth England, Siobhan Reilly, Richard Byng, Linda Gask, Mike Clark, Peter Huxley, Peter Lewis, Maximillian Birchwood, Melanie Calvert

Potential of digital technologies and therapies for children and young people.

Dowrick discusses the role of computerised cognitive behavioural therapy (cCBT) in guided self help among adults.1 For mental health illness in children and young people, such help potentially offers a familiar and accessible means of accessing therapy. In an average class of 30 schoolchildren, 10% will have experienced mental health illness. …