Transcript WAHSN Away Day

A Revolution in Psychosis Care:
Learning from Stroke Pathway
Dr Shanaya Rathod, DM, MRCPsych
Consultant Psychiatrist, Southern health NHS
Foundation Trust
Mental Health Clinical Lead: WAHSN
• Schizophrenia and psychosis cost society £11.8 billion a year
• Increasing numbers of people are having compulsory
treatment, in part because of the state of many acute care
wards
• Only 1 in 10 of those who could benefit get access to true
CBT
• Only 8% of people with schizophrenia are in employment
• Only 14% of people receiving social care services for a
primary mental health need are receiving self- directed
support
• Families who are carers save the public purse £1.24
billion per year
• 87% of service users report experiences of stigma and
discrimination.
'More than 80% of patients with their
first episode of psychosis will
recover …. less than 20% will never
have another episode.
Quoted by Marco M Picchioni, clinical lecturer in psychiatry and
Robin M Murray, professor of psychiatry (2004)
Robinson D, Woerner MG, Alvir JMJ, Bilder R, Goldman R,
Geisler S, et al. Predictors of relapse following response from a
first episode of schizophrenia or schizoaffective disorder. Arch
Gen Psychiatry 1999;56:241-7.
Cost of Psychosis
•
• Early Intervention: net
savings of £7,972 per
person after four years
•
•
•
• Peer support: £4.76
can be gained for
every £1 invested.
• CBT: Cost per QALY
gained of £27,373 for
CBT compared to
usual care
It is not about £££££££…….
How do we make it happen?
• Learn from other pathways - Stroke
• Intelligence-driven: Use of Information
• Evidence-based – NICE Clinical guidelines; National
Audit of Schizophrenia
• Care pathways
• Supported by:
– Users & carers advocacy
– Effective commissioning – funding?
– Clinical Leadership
– Training
– Robust Implementation
Psychosis Pathway
Acute care pathway
EIP pathway
Assertive outreach pathway
Community mental health pathway
H
Pre-psychosis
Early psychosis
Persistent psychosis
Recovery
EVIDENCE-BASE
(Factsheet)
Psychosis Pathway
Early intervention (Factsheet)
CVS & MH (Factsheet)
Severe mental illness (Factsheets & Webpage)
SMI & crisis (Webpage)
GOOD PRACTICE
QUALITY
Diabetes (Factsheet)
Neuro (Factsheet)
INDIVIDU
AL
COSTING
Acute care pathway
EIP pathway
STRATA
Assertive outreach pathway
Incentivise flow
HIGH COST
COMMUNITY
Community mental health pathway Y-O-C
COMMUNITY CLUSTERS
Data points
Cancer (Factsheet)
Perinatal (Factsheet)
Early intervention (examples)
Psychological treatment (information)
Psychosis services (examples)
Inpatient care (examples)
Community
services
(examples)
Choice
of Provider
Access & Waiting Time targets
Physical health CQUIN
NICE standards
Care Quality Commission
NHS Choices
HIGH COST
INPATIENT
Pre-psychosis
Smoking
Early psychosis
Persistent psychosis
Recovery
Regular outcome measurement
(HoNOS, PREM, Recovery PROM)
Revolution in Psychosis Care
•Led by WAHSN
•Support from NHSE
•Royal College of Psychiatrists
Revolution in Psychosis Care
•Steering Group
•Information
•Service user led
•Clinical engagement
• Implementation
•Evaluation