In this guest blog, Andrea Mechelli welcomes the introduction of maximum waiting times for people experiencing symptoms of psychosis and how it could end up bringing large human and economic benefits.
Since 1991, people experiencing certain physical illnesses have benefited from the right to access NHS services within maximum waiting times. But people struggling with mental health symptoms have not had the same quick, easy access to the right care – until now.
April 1 saw a landmark change to the provision of mental health care by the NHS. For the first time, maximum waiting times are set in place for people needing mental health care on the NHS. Now, individuals experiencing symptoms of psychosis can expect access to early intervention services within 14 days of referral. This is critical because the earlier someone experiencing psychosis receives treatment the more likely they are to make a full recovery.
Psychosis is characterised by symptoms such as hallucinations and delusions, and can have a devastating impact on everyday life, leading to social isolation and loss of education or employment. Historically, people with psychosis have often been misunderstood, stigmatised and even hidden from public gaze behind the walls of lunatic asylums. Even after the closure of the last public mental hospitals and the rise of community-based care in the 1980s, psychosis was considered a malignant disease by the medical profession and general public alike. But over the past two decades this overly-pessimistic view has been replaced by a new paradigm that emphasises the clinical benefits of early intervention and the potential for long-term recovery.
Early intervention services for psychosis differ from traditional mental health services with respect to three main aspects.
Firstly, they strive to provide people with quick and easy access to treatment when they first become unwell. In some cases, treatment is provided to people who experience the early warning signs of psychosis, such as mild hallucinations, but do not meet criteria for a formal diagnosis of psychosis: here the aim is to prevent the onset of the illness altogether. In other cases, treatment is provided to those who have suffered a full-blown episode of the illness, where the aim is to prevent further relapses.
Secondly, early intervention services for psychosis provide a personalised treatment plan that is informed by personal history, individual needs and stage of illness of each patient. This person-centred approach represents a major shift from the ‘one-size-fits-all’ model that was prominent until the late 1990s. It also aligns mental health care with other areas of medicine, such as cancer and cardiovascular disease, where different treatments are available depending on the stage of the illness.
Thirdly, early intervention services for psychosis strive to offer holistic support, in which mental and physical health care are integrated. This is vital because, compared to the general population people with psychosis tend to exercise less, smoke more and have a poorer diet, resulting in higher levels of diabetes, obesity, high blood pressure and a reduction in life expectancy of about 15 years.
As part of this holistic approach, patients may receive expert advice and practical support in other areas of their life, such as housing and employment. This is based on increasing evidence that everyday stressors, such as unstable living conditions and problems at work can have a detrimental impact on the long-term course of the illness.
Patients with a first episode of psychosis who receive early intervention tend to recover faster and are less likely to relapse. These findings have led the National Institute for Health and Care Excellence to recommend that early intervention should be available to anyone experiencing a first episode of psychosis. The benefits of early intervention are good news for patients and healthcare providers. People who receive early intervention, relative to standard care, are less likely to require hospital admission – a key driver of mental health care cost – resulting in savings of up to £36,000 to the NHS per patient.
If these estimates are correct, the comprehensive implementation of early intervention in psychosis across England could save the NHS up to £40 million each year. But the benefits of such implementation to the wider society would be even broader. Patients who receive early intervention are more likely to remain in education or employment than those in standard care, resulting in savings of £2,087 per person over a 3-year period. In addition, early intervention is associated with a reduction in risk of suicide, resulting in an annual savings of £957 per person. While it would be clearly reductive to measure the impact of early intervention in economic terms, these data demonstrate human as well as economic benefits.
It is ironic that early intervention services strive to provide people with quick and easy access to the right treatment, yet until this month some people would have to wait several months or longer to access those services. Following the introduction of the maximum waiting times, all individuals with psychotic symptoms should receive the same quick, easy access to the right care. While this is a step in the right direction, it is critical that this landmark change provides a blueprint for other areas of mental health, allowing people with any mental illness to receive timely, person-centred and comprehensive support.
About the author
Andrea Mechelli is the director of the MSc Early Intervention in Psychosis at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, and a clinical psychologist working in the NHS. The focus of his teaching, research and clinical practice is early intervention in psychosis.