The Psychosis Health Integration Team has eight work streams that it will focus on:
- Physical health
- Care pathways
- Families and networks
- More caring crisis response
- Staff health
People with psychosis are less likely to be in employment or full-time education than the general population: approximately 9 per cent are working full-time and 19 per cent part-time. It is important to understand the reasons for this and the impact that wider structures and social policies have on people’s access to work.
It is important not to compel a return to work, but to ensure that people are given an equality of opportunity to do so should they wish, with appropriate support.
The team will identify what support and services are offered in Bristol, and evaluate each, including Mental Health Matters and Bristol Employment Support Service (BMH). It is likely that these are generic interventions, and so the team will develop specific interventions tailored to the needs of people with psychosis.
The team will develop education and training for staff in employment institutions and for local employers, to reduce stigma and improve the confidence to offer opportunities to people with psychosis.
Improve appropriateness and therapeutic value of hospitalisation
Approximately 50 per cent of people with psychosis have been admitted to hospital at some point in their illness. While the Psychosis HIT will aim to reduce the number and duration of hospital admissions, it should also be accepted that there are circumstances when admission is necessary and beneficial.
There is a national shortage of psychiatric beds and the average duration of hospital admission is reducing. This adds pressure for people to be discharged from hospital prematurely. People with psychosis are frequently admitted to inappropriate beds – either in general hospitals, to other cities or in other settings. Service users also report that the hospital environment is not therapeutic.
The team aims to understand the experience of people with psychosis who are admitted to hospital to inform development of hospital environments to better meet their needs. They will work with Liaison Psychiatry to evaluate the scale of, and aim to minimise, admissions to general hospitals.
Improve general (physical) health outcomes
NICE states that the life expectancy for adults with psychosis is between 15 and 20 years less than for the general population. The reasons for this are complex and poorly understood. People with psychosis often have physical health problems that can be exacerbated by the use of antipsychotics. There is a higher incidence of smoking in this patient group and less engagement in exercise.
It is vital that the physical health of people with psychosis is comprehensively assessed and that appropriate physical health interventions are offered. The Psychosis HIT aims to address these issues locally by developing links between primary and secondary care for these patients. An important focus will be evaluating adherence to NICE guidelines.
Better integration of care pathways
Recent changes to mental health care services have led to more interfaces between providers, one of which is between primary and secondary care. Users and carers describe the complexity of navigating the service to get their needs met.
The Psychosis HIT aims to understand the routes people take through various care pathways to improve interfaces. People should receive the help they need in the way that they would like, as quickly as possible. The HIT will identify where people may seek help outside services and the barriers to seeking help from health care services.
Greater emphasis on the relationship with trauma
There is growing evidence of an association between psychotic experiences and trauma. Many service users find that professionals are interested in the content of their psychotic experiences in order to explain the nature of their difficulties. This approach aims to reduce distress, normalise, support and help guide future treatment decisions. Many users feel that their stories, particularly traumatic experiences, are not asked about or heard when they meet health care professionals.
The Psychosis HIT will hear the voices of users and carers to educate mental health staff and staff in other settings to be aware of the relationship between psychosis and trauma, and feel more confident to ask someone about all of their experiences.
Better engagement with people’s networks from the outset
Feedback from carers and families locally is that they often feel excluded from clinical meetings and treatment decisions. NICE guidelines state that people should have access to family work and family therapy. There have been recent innovations in other parts of the UK which may be helpful, such as community health networks.
The Psychosis HIT aims to educate existing clinicians to help them feel more skilled to involve families and networks throughout someone’s care pathway.
More caring crisis response
A frequent experience of service users and carers, contacting mental health services when in crisis, is that the response they receive lacks empathy and is inhumane. The challenge are the statutory requirements that crisis services have around assessing and managing risk.
While understanding the pressures staff are under in working in crisis services, the Psychosis HIT wants to develop training to align the delivery of crisis response with what service users and carers want. This might involve a shift in emphasis away from offering advice towards offering understanding.
Improving staff health: the impact of working with people with psychosis
The impact of working with psychosis patients has been explored in psychoanalytic and psychotherapy literature. But interventions to help staff who work with those in significant distress and extreme psychological states remain underdeveloped and unevaluated.
The Psychosis HIT will survey the experience of staff working with people with psychosis, and develop strategies to improve awareness of the impact on staff health. The team will develop interventions to keep the local workforce healthy in the workplace.