Title: Optimising the delivery of ‘Early Intervention in Psychosis’ services: a mixed-methods study.
Funder: Department of Health and Social Care

Abstract: Background People with psychosis experience high levels of mental distress, reduced social functioning and premature mortality - but there is marked variation in these outcomes. In an effort to ensure that people with psychosis receive effective treatment, 'Early Intervention in Psychosis' (EIP) services were set up throughout the UK and internationally. These services aim to deliver a package of evidence-based treatment in a timely manner. However, data from national audits have revealed marked variation in the quality of care they deliver. Reasons for this variation and its impact on patient outcomes is not known. Aims and Objectives To identify which components of the organisation and delivery of EIP services are associated with enhanced patient experience and better patient outcomes, and explore the mechanisms underlying these associations. Methods A sequential mixed methods study comprising three linked work-packages. In work-package one, I will conduct a secondary analysis of data from a survey of over 2000 patients who took part in the National Clinical Audit of Psychosis. I will examine associations between service delivery and patient-reported experience. In work-package two, I will link data from a case-note audit of over 10,000 patients using EIP services with data from NHS Digital. I will conduct a patient-level analysis of the relationship between the care that patients receive from EIP services, and their outcomes (admission to hospital, attendance at emergency departments and use of compulsory treatment) over the next three years.In work-package three, I will collect and analyse qualitative data from in-depth interviews with managers, front-line staff, patients and carers. This analysis will examine the experience of treatment (from multiple perspectives) and investigate how, why, and for whom specific components of care impact (or fail to impact) on patient outcome. The analysis will also explore the meaning of associations between interventions delivered and outcome identified in the earlier work-packages. Anticipated Impact and Dissemination I will publish the results of these studies in peer-reviewed journals, prioritising publications widely read by service providers and researchers in the field of early intervention. I also plan to ensure significant findings are communicated to other stakeholders (eg patients and carers), as well as lay audiences, by working with mental health charities and using social media. In addition, I will circulate results via the Royal College of Psychiatrists' 'EIP Network' - the foremost quality improvement and accreditation network for EIP teams in the UK. Finally, I will present my findings at interdisciplinary conferences, to ensure that relevant information is disseminated amongst practitioners in wider mental health services. My collaborators have close links to professional and regulatory bodies, who can assist in ensuring that the results of the study reach necessary stakeholders and that implications for policy and clinical practice are fully realised. Results from this project will help to inform guidelines for the structure and operation of EIP services. Ultimately, these aim to optimise outcomes for people with psychosis and the wider society by ensuring more effective use of available resources.

Lay abstract: Psychoses are severe mental health conditions in which people experience hallucinations and paranoid beliefs and can lose touch with reality. Psychotic symptoms can be very confusing and upsetting, and interfere with people's ability to study, work and maintain relationships. More than 1 in 100 people will suffer from psychosis during their lifetime. Psychosis is more common in some ethnic and demographic groups, and may be linked to experiences of trauma and inequality. Symptoms typically start during adolescence or early adulthood and can persist for long periods or even for life. There are effective treatments for psychosis, including medications and psychological therapies. Support for patients' families, and practical help with education and employment are also important. To try to ensure that all people who develop psychosis get the best available treatment when they first become unwell, special services called 'Early Intervention in Psychosis' (EIP) teams have been set up throughout England. These EIP teams work with people suffering from psychosis during the early stages of their illness. Studies have found that people treated by EIP teams have better outcomes than those who are not. In 2019 a national audit of EIP teams found large differences in the care they provide. For instance, only half of people received a recommended psychological therapy called Cognitive Behavioural Therapy for psychosis, and only a third of patients' families received proper support. Currently, we do not know what the reasons are for these differences, or whether differences in the treatment that people receive have an impact on their experience of care or future health.I plan to conduct a study of EIP teams in England to answer some of these questions. Firstly, I will complete a detailed analysis of information gathered during the national audit to see whether patients who received specific kinds of treatment had a better experience of care. I will then follow up the same patients, using information from other sources held by the NHS. I will be able to find out what happened to the patients from the audit over the last three years - whether they needed hospital admission or emergency mental health treatment in A&E, or were detained under the Mental Health Act. I will examine whether patients who received different types of treatment were more or less likely to have needed these additional types of support later on. Finally, I will interview people who use and provide EIP services to examine reasons why there are differences in the treatment that patients receive. I will aim to get a better understanding of how the treatment that people receive has an impact on how satisfied they are with their care, and on their future use of health services.I will include a wide range of people from different social and ethnic backgrounds in this research. Throughout the project, I will be advised by a group of people who have used EIP services. At each stage this group will help me to make sure the research is explained clearly, and that the questions I ask are meaningful and important to the people I am trying to help. I will use the findings of the study to get a better understanding of how the treatment and care delivered by EIP teams affect outcomes for patients. I will then work with colleagues to make recommendations about how services should be delivered in the future. This will help ensure that EIP teams offer the best possible care to their patients, and help to improve the lives of people with psychosis.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH