Making a difference early in psychosis
Psychosis is a common, disabling disorder that costs the UK economy an estimated £11.8 billion per year. People can be affected by psychosis at any age.
‘Early Intervention in Psychosis’ (EIP) services provide psychological and family therapy and engagement for young people (aged 16-35) presenting with a first-episode of psychosis, in a youth friendly setting.
Evidence from randomised controlled trials shows that these specialist community treatment teams both reduce inpatient bed use and improve clinical outcomes, with an overall cost saving.
However, despite this evidence, many EIP services have been either lost, or the fidelity to the original model has been reduced (Rethink, 2013).
We therefore looked to examine whether the implementation of EIP services into NHS practice, outside of the RCT setting, also resulted in improved outcomes and cost savings.
The CLAHRC and its project partners, Jannsen Healthcare Innovation and Oxford AHSN’s Early Intervention in Psychosis Network, initiated a project to look at health service use by psychosis patients in the Thames Valley, over a three-year period.
The project used Jannsen Healthcare Innovation’s unique ‘case identification and data linkage’ methodology with data from routine mental health system and secondary care physical health system databases – the Mental Health Minimum Data Set (MHMDS) and Hospital Episodes Statistics (HES) databases, respectively.
This data then served as the basis for an economic evaluation of the services.
More than 4,640 patients were identified for the study and 20 per cent were found to have been treated under an EIP service. Rates of admission to mental health hospitals, length of stay, employment outcomes and A&E attendances were compared between those who were treated in an EIP service, and those who were not.
The study revealed that savings of using EIP services could equate to £5,200 per patient in EIP per year, and include significantly fewer mental health bed days and reduced attendances at A&E.
If all people with a first-episode psychosis across England were to be treated by EIP services, the savings in societal costs would be an estimated £63.3 million per year, of which £33.5 million would be savings to the NHS.
This evidence was accepted by the BMJ Open for publication and resulted in an invitation by NHS England to organise a national expert reference group to draft the first mental health Referral to Treatment Time for EIP, submitted to the Health and Social Care Information Centre in December 2014 and published by NICE/NHS England in 2016.
On a local basis, by providing unambiguous evidence of service improvement and the resulting patient benefit, CLAHRC Oxford paved the way for Oxford AHSN to widely implement and facilitate adoption of this innovative approach to mental health care for young people with psychosis.
The project was showcased in the ‘saving lives, saving money’ chapter of the NIHR Annual report 2014/15.