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This paper seeks to outline the nature of early intervention (EI) services in psychosis and to discuss substance use in clients in this setting. It considers ways of working with EI clients where substance use is an issue.

The paper begins by outlining the nature of EI services and early psychosis, then goes on to discuss the impact and management of substance use in this setting.

The authors argue that the El approach may be very appropriate for this subset of clients.

This paper focuses on the issues of treatment of dual diagnosis within a specialised area of mental service provision. EI services for psychosis aim to provide early detection and treatment of psychosis, particularly through increased emphasis on psychosocial interventions.

The onset of psychosis typically develops during adolescence, a crucial period for beginning the transition from family to independence and developing a stable sense of self. Recovery amongst adolescents experiencing early onset psychosis has not yet been investigated with reference to its influence on self-identity. The purpose of this paper is to explore the impact living with early onset psychosis has on self-identity for adolescents in recovery.

A purposive sample of ten adolescents aged between 16 and 18 years from an Early Intervention Service in the Scottish National Health Service were recruited. All had experienced at least one episode of psychosis and were within three years of first contact with the service. Semi-structured interviews were adopted to capture adolescents’ perspectives concerning their experiences of recovery from psychosis and the impact on self-identity. All interviews were audio-recorded, transcribed and thematically analysed.

Qualitative analysis of adolescents’ accounts revealed how recovery from psychosis involves working with individual explanatory frameworks concerning uncertain identities and status ambiguity, a decrease in referent points and unfavourable social comparisons (emphasising loss, grief and self-criticism).

Supporting adolescents experiencing early psychosis involves education, rebuilding relationships with self and others and providing access to psychotherapeutic interventions to aid self-identity development when needed.

The originality of this paper lies in the importance of identity, recovery, human reconnection, advocacy and community reintegration for adolescents experiencing psychosis. Public mental health campaigns to tackle the stigma surrounding psychosis are essential to assisting adolescents in developing their sense of self through their recovery journeys.

This study aimed to determine the level of training in psychosocial interventions among staff in the 119 early intervention in psychosis (EIP) teams that were established at the time. A brief questionnaire was sent to each of the teams asking for details of the composition of the team, and for details of any training in psychosocial interventions (PSI) the members of the team had undergone. Fifty‐two questionnaires were returned (44%). Over half of the teams had input from social workers, clinical psychologists and occupational therapists to compliment the nursing provision, though less than 50% employed support workers or had specific psychiatry input. All but two of the teams returning the questionnaire had members of staff trained in PSI though the type of training tended to reflect availability of local training provision. The results are discussed and practical recommendations are made to ensure evidencebased care is implemented within EIP.

This paper presents the outcomes of a small qualitative study investigating the experience of mental health practitioners working with dual diagnosis in an early intervention in psychosis (EIP) team with a focus on the use of a specifically developed screening tool. Interviews were conducted with mental health professionals who were employed as care co‐ordinators within an EIP team. Grounded theory was adopted as a method for making sense of the data obtained. Six themes that emerged from the data are described: the importance of the cycle of change in treatment planning; service accountability and responsibility; the nature of psychotic illness; assumptions about substance use; confidence; and using the tool as part of the recovery process. These themes were discussed in relation to research surrounding psychosis, substance use and screening methods.Despite identifying the importance of a more integrated method of working with this complex service user group, gaps remain in practice. Modifications to the screening tool are recommended and a need for substance‐use‐specific interventions training for practitioners working within EIP services is identified.

The purpose of this paper is to improve the quality of monitoring of risk factors that predict the likelihood of people with severe mental illness (SMI) developing cardiovascular disease (CVD), diabetes and obesity, major contributors to poor physical health and risk of premature mortality.

The first phase of the AQuA “Don’t just screen-intervene” initiative supported five specialised community-based Early Intervention for Psychosis services in North West England to assess the effectiveness of monitoring of cardiometabolic risk in their patients using standards derived from the Lester Positive Cardiometabolic Health Resource, a nationally acknowledged framework for people with psychosis receiving antipsychotic medication. The initial findings formed the basis for a quality improvement programme which ran from November 2012 until May 2013.

By the end of a six month quality improvement programme the likelihood of a patient receiving a comprehensive cardiometabolic risk screening (evidenced by recorded measurement of body mass index or waist circumference, blood pressure, blood glucose and lipid profile, assessment of smoking status and enquiry of relevant family history) had increased from 10 to between 63 and 80 per cent.

Cardiometabolic risk monitoring from the onset of psychosis and its treatment can be improved utilising quality improvement methodology in real-world specialist mental health services. Earlier identification and treatment of risk factors that predict higher rates of obesity, diabetes and SMI may help people with SMI avoid life-restricting and life-shortening physical disorders.

Given the National Audit of Schizophrenia findings of inadequate screening in those with established SMI alongside evidence that CVD risk can emerge early in the course of psychosis, a group of early intervention in psychosis services in North West England decided to examine this aspect of their routine clinical practice. This service evaluation describes the effectiveness of a quality improvement programme based on the Lester Positive Cardiometabolic Health Resource (referred to as Lester resource henceforth) to improve the effectiveness of monitoring of risk factors that predict the likelihood of people experiencing psychosis and schizophrenia developing CVD diabetes and obesity.

A combination of social disadvantage and unhealthy lifestyles, adverse cardiometabolic impacts of antipsychotic medication and inequitable access to physical healthcare combine to put people with SMI at particular risk from CVD, the single biggest cause of premature death, and much more common than suicide (Brown et al., 2010). Despite higher rates of potentially modifiable CVD risk factors (De Hert et al., 2009) people with SMI appear to be missing out on opportunities to actively prevent conditions like CVD and diabetes compared to the general population.

People with SMI such as schizophrenia die 15-20 years earlier on average than the general population. Around 20 per cent of premature deaths can be explained by suicide and injury, but the remainder arise from a variety of natural causes such as CVD, chronic obstructive pulmonary disorder and certain cancers and infections (Nordentoft et al., 2013). The authors worked with five mental health trusts in the North West of England covering a sample of over 500 cases within early intervention services.

Peer support (PS) has, over recent years, been implemented across a variety of NHS adult mental health settings. In November 2015, peer support workers (PSW) were introduced to an Early Intervention in Psychosis Service (EIS) in the Midlands. The purpose of this paper is to focus on organisational factors, asking how do PS impact on an early intervention in psychosis multi-disciplinary team (MDT).

Six EIS MDT members participated in an hour-long focus group. The data were analysed using thematic analysis, in line with a qualitative methodology (Braun and Clarke, 2006).

Two themes were generated, including “The values of PS” (consisting of three sub-themes: improving service engagement; personal qualities; and the peer relationship); and “The peer support role” (consisting of three sub-themes: living experience; boundaries; and alternative perspectives). Findings imply that PS in the current EIS related to: improved service engagement and greater understanding between service providers and users; which could be linked to better outcomes for service users (such as reduced duration of untreated psychosis (DUP)).

It has been suggested that PSWs facilitate an improved understanding between service providers and service users (Repper and Watson, 2012). However, research into organisational and team benefits of PS is lacking, with a need for more exploration (Repper, 2013). The current study begins to address the lack of literature regarding the organisational impact of PS, and even further regarding early intervention.

The purpose of this paper is to determine the effectiveness of community outreach efforts in promoting public education on the early warning signs of psychosis and in generating referrals for treatment during the prodromal stage of illness.

Five mental health centres across the United States implemented a community outreach model known as the Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP). A multi‐site evaluation was conducted to assess whether the model's outreach objectives could be achieved among replication sites in geographically and demographically diverse locations. The assessment included the analysis of data from three main sources: administrative data, structured qualitative interviews, and participant self‐report surveys.

Results demonstrated that the outreach activities in all five sites resulted in increased awareness of participants about the early warning signs of psychosis, the availability of local treatment options and increased knowledge of the referral process. There were benefits of outreach participation regardless of whether the participant was a professional or non‐professional in the community. Additionally, outreach participants showed a significant increase in their likelihood to refer a young adult for a mental health evaluation.

Community outreach can be an effective tool for mental health centres in developing a local network that can generate timely referrals for early intervention programmes and clinical research. Results also show that relatively brief community engagement efforts can significantly increase the knowledge and awareness of the public on complex mental health conditions where early detection may be integral to effective treatment.

The purpose of this paper is to describe the University of Exeter Family Interventions (FIs) training programme for the South West region which was commissioned as part of the NHS England Access and Waiting Times standards (A&WTS) initiative for early psychosis. This programme (10 taught days and 6 months of supervised practice) is designed to maximise implementation in practice.

The programme introduces students to a flexible, widely applicable FI approach which integrates cognitive behavioural/psycho-educational and systemic approaches. It refreshes and develops CBT-based psycho-social intervention skills, so that clinicians feel confident to use them in family sessions and integrate these with foundation level family therapy skills. The approach facilitates engagement, and it is designed so that every session is a “mini intervention”. This enables clinicians to offer standard NICE-concordant FI or a briefer intervention if this is sufficient to meet the particular needs of a family.

This paper provides details of the regional training programme and evaluates the first four training courses delivered to nine early intervention in psychosis teams. It considers how a combination of training a critical mass of staff in each service, ongoing supervision, regional events to maintain skills and motivation to deliver FI, and the national and regional auditing of FI as part of the A&WTS all contribute to clinical implementation.

The unique design of this programme maximises implementation in practice by virtue of its widely applicable integrated FI approach, the focus on ongoing skills development and by embedding it within regional and local service support structures.

The current risk management system for community mental health patients in England is based around the Care Programme Approach (CPA). This system is not responsive to changes in risk for community patients. This paper aims to introduce a practical system to manage risk that has been developed for an Early Intervention Service in East London on the basis of need.

Coding of red, amber and green is associated with specific criteria agreed by all disciplines in the team. The change of a code leads to a rapid change in risk level and management. An agreed clinical and non‐clinical action plan leads to a whole team response. The limitation of use is dependent on the size of the case load and the number of clinical staff attending a daily clinical briefing.

Zoning according to the traffic lights system could complement the CPA system and support a clinical governance structure utilising a whole team response.

The risk management system described has not been tested empirically. Currently it has been used in early intervention mental health teams but will need to be adapted for other teams with bigger case loads.

This practical risk management system is aligned with the statuary CPA requirements. A dynamic and flexible management of risk is central to early intervention in psychosis teams but the risk management system described can suit any community mental health team and fits well with the distributed responsibility model of functionalised teams according to new ways of working.

Several decades of mental health research in the UK repeatedly report that people of African-Caribbean origin are more likely than other ethnic minorities, including the White majority, to be diagnosed with schizophrenia and related psychoses. Race-based inequalities in mental healthcare persist despite numerous initiatives such as the UK’s ‘Delivering Race Equality’ policy, which sought to reduce the fear of mainstream services and promote more timely access to care. Community-level engagement with members of African-Caribbean communities highlighted the need to develop culturally relevant psychosocial treatments. Family Intervention (FI) is a ‘talking treatment’ with a strong evidence-base for clinical-effectiveness in the management of psychoses. Benefits of FI include improved self-care, problem-solving and coping for both service users and carers, reducing the risk of relapse and re-hospitalisation. Working collaboratively with African-Caribbeans as ‘experts-by-experience’ enabled co-production, implementation and evaluation of Culturally adapted Family Intervention (CaFI). Our findings suggests that a community frequently labelled ‘hard-to-reach’ can be highly motivated to engage in solutions-focussed research to improve engagement, experiences and outcomes in mental health. This underscores the UK’s Mental Health Task Force’s message that ‘new ways of working’ are required to reduce the inequalities faced by African-Caribbeans and other marginalised groups in accessing mental healthcare. Although conducted in the UK (a high-income multi-cultural country), co-production of more culturally appropriate psychosocial interventions may have wider implications in the global health context. Interventions like CaFI could, for example, contribute to reducing the 75% ‘mental health gap’ between High and Low-and-Middle-Income counties reported by the World Health Organization.