As we publish a new report on the importance of early intervention in psychosis, our clinical lead for this work, Dr Suzy Clark, outlines how those with psychosis have been helped under the COVID-19 restrictions and how our new report will benefit people with psychosis across the country.
Psychosis was already on the increase when the pandemic arrived, but there have been noticeably more new presentations of psychosis since last March of 2020. Approximately 1,600 people in Scotland experience a first episode of psychosis each year, and since March 2020 data from NHS Greater Glasgow & Clyde’s ESTEEM service, where I am the consultant clinical psychologist, showed a 20-25% increase in caseload.
It’s easy to see how the events of the last year can have affected people profoundly. Many people have had important life transitions, such as leaving home to go to university, thwarted. Social networks are diminished and people miss their peer group contact and there is a lack of structure to their day. Moreover, with the restrictions in place, it has at times taken longer for people to get referred and the psychosis is often more severe by the time they do.
Impact of COVID-19 on Early Intervention Services
For an Early Intervention Service to be required to be socially distanced – and not to have face to face contact – is the antithesis of how it would normally operate. But this was a necessary requirement as we all dealt with the first wave of the pandemic.
Accessibility and engagement, getting alongside the person with psychosis for a coffee or a walk or to help with housing, are key aspects to the early stages of intervention All of this has been much more difficult during COVID-19. Many of the interventions the service would routinely offer such as group meetings, family events for carers, face-to-face contact with clinicians, were discontinued. Staff were sent home abruptly and a rota provided cover in the office. At ESTEEM, we lost our clinical rooms to support new Mental Health Assessment units and clinical work was focused on contact with people with acute psychosis and at risk of admission.
Fortunately the service had been piloting digital delivery and the pace of this work then accelerated. Clinicians adapted quickly to the use of Near Me and learnt to share documents and still hold team discussions online.
Learning to cope
Many people with psychosis surprised themselves with how well they coped during lockdown, finding the skills they had learnt to help with their mental health also helped with general wellbeing, such as regular fresh air and exercise, planning your day in chunks of time and not giving yourself a hard time if you are not that productive.
For others, it has been a very difficult time. People with psychosis missed the face-to-face contact, but recognised the need for remote working; some also reported benefits, for example, fitting sessions around work commitments and being more able to talk about difficult things at a distance.
Getting back up and running
Gradually, more routine work was remobilised. Supervision structures, Behavioural Family Therapy, Family & Friends support groups, and psychological therapy restarted online in the summer of 2020 and are continuing to work well. There were some inevitable hiccups with the technology, but gradual improvements to functionality has helped enormously. Attendance has been good: staff, those with psychosis and their carers appreciate the opportunity to connect online.
Raising the standard across Scotland
During the pandemic, Healthcare Improvement Scotland produced a new report outlining how early intervention in psychosis can be delivered in urban, semi-urban and rural communities, tailored to local context.
The report found that there is significant variation across Scotland in the provision of care and treatment for people with first episode psychosis. Moreover, people who experience delays in initial access to services are more likely to have contact with out of hours, crisis or emergency services.
It’s our hope that this report will help NHS boards to understand how best to establish and run services in order to provide the best care to people at the very earliest opportunity. We are extremely grateful to the people with lived-experience of psychosis who contributed to this work.
Looking to the future
Looking forward, I’m confident that the new report will help to improve services across the country. Digital technology will no doubt continue to play a role in delivering care. I believe digital service delivery is here to stay- although I anticipate a blended approach going forward. Being in the room with a highly distressed person to help them feel less alone will never be replaced.
As for the future, at ESTEEM we’re planning to introduce walking groups and cycling groups for the spring of 2021 and I think we will all take forward a renewed appreciation of the value of social connections for well-being and recovery. Let’s hope that the difficult time that everyone has been through creates a more energised space for delivering effective care, especially for people with psychosis
.Dr Suzy Clark is Consultant Clinical Psychologist Clinical Lead at Healthcare Improvement Scotland and Consultant Clinical Psychologist in the ESTEEM Early Intervention Service at NHS Greater Glasgow & Clyde.