Title: Personalised Care for Early Psychosis
Funder: Department of Health and Social Care

Abstract: RESEARCH QUESTION What is the impact of duration of early intervention in psychosis treatment on health outcomes? BACKGROUND Early Intervention in Psychosis (EIP) services are phase-specific community mental health teams that treat people with first episode psychosis (FEP). EIP is currently time-limited to 3 years, with the rationale that early intensive treatment will preclude the need for ongoing care (a secondary prevention approach). It is not known what the optimal length of EIP treatment should be. People with FEP have diverse illness trajectories, meaning eventual outcome is not easy to predict. Some people may benefit from longer treatment. Alternatively, the length of treatment may not be so important, but instead the delivery of specific treatments may be the most important predictor of a good outcome. We want to determine whether a flexible, needs assessed EIP treatment could become an alternative to the current time-limited service. By leveraging current variation in the delivery of EIP across England we will explore whether this variation results in different outcomes. AIMS To understand current EIP provision. To investigate the impact of the duration of EIP treatment on health outcomes. To estimate the cost-effectiveness of flexible, needs assessed EIP services. To develop evidence-based guidance to guide clinical decision making and commissioning. METHODS We will use data from over 10,000 individuals, collected through the National Clinical Audit of Psychosis (NCAP) linked to routinely collected hospital and outpatient records. We will have data on individual, service, and regional variation in the delivery of EIP, individual service use and patient reported outcomes. We will undertake qualitative interviews with patients, carers, health professionals, and commissioners to understand different experiences of EIP delivery and how decisions about informal and formal changes to delivery of care are made. We will then apply g-methods and a target trial framework (emulating randomised trial methodology in observational data) to our linked dataset to ascertain the causal relationship between duration of EIP treatment and outcomes. We will complement our causal study with detailed case studies of the current informal methods of varying the duration of EIP outside of the current time-limited service models. Using economic models, we will compare the cost-effectiveness of time-limited EIP to a more flexible provision, and perform a budget impact analysis to provide decision-makers with detailed evidence of investment needed for population level changes to EIP services. Finally, together with the Centre for Mental Health, we will work with key stakeholders and commissioners to determine what changes in policy are necessary to implement evidence generated from this research. TIMELINES This is a 36 month programme. Data-linkage will be obtained by month 6, evidence to inform the causal model by month 12, and evidence of the impact and cost-effectiveness of flexible EIP by month 36. ANTICIPATED IMPACT AND DISSEMINATION Evidence from this research will inform national commissioning of EIP services. The generation of a large, linked dataset will create opportunities for building further research capacity and collaborations. The Centre for Mental Health will disseminate evidence to both public and policy makers.

Lay abstract: Psychosis is a term used to describe when people lose some contact with reality. This might involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions). Getting help as early as possible is vital for the individual and the family. Early Intervention in Psychosis (EIP) services offer treatment in the community which can include medication, talking therapies, education about psychosis, physical health advice, and regular contact. There are over 150 EIP teams in England who treat over 10,000 new people per year. Research has shown that EIP is effective, that people prefer it to other forms of treatment, and the service saves money overall. EIP is typically given for three years to everyone. After this time, those who are well are discharged to their GP, while those with ongoing symptoms are transferred to a general community mental health team. People often become unwell at this time of change and might benefit from longer treatment with EIP. We also know that some people could possibly have been discharged back to their GP earlier. So, we don't know the best length of EIP treatment for an individual, or who might benefit from longer or shorter periods of care. We want to develop a more tailored approach and understand the health, social, and cost benefits of this. We will use data from the annual National Clinical Audit of Psychosis that collects data on individuals being treated in every EIP service across England. We will link audit data to routinely collected NHS hospital and GP records. We will take advantage of the variation in duration of EIP across the country. We will identify differences between people who receive longer or shorter EIP treatment and explore whether differences in length of EIP care lead to different outcomes. To do this we will also have to control for the fact that generally people who receive longer treatment tend to be more unwell. We will also interview people treated by EIP, their carers and clinicians to understand why and how decisions about care are made. Finally, we will find out how differences in duration of EIP influence the short- and long-term cost-effectiveness of the service, and determine what policy changes are needed to make EIP more flexible to people s needs. We will consult widely to ensure different voices are heard. Our entire research project will be overseen by a group of EIP service users and carers. This group, led by a service user and carer, will make sure the research is explained clearly; help us create the questions that are important for our interviews; and help us develop, promote and share our research findings.

Research activity codes: 8.2 HEALTH AND WELFARE ECONOMICS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH