The THEIS and THEDS team work closely together to go above and beyond expected provision by continually thinking of ways to support service users and their families to engage with services and the wider community. We do this to develop coping skills and resilience and achieve their potential in one of the most culturally diverse boroughs in the country.
What We Did
The THEIS and THEDS team work closely together to go above and beyond expected provision by continually thinking of ways to support service users and their families to engage with services and the wider community. We do this to develop coping skills and resilience and achieve their potential in one of the most culturally diverse boroughs in the country. For example, the National Institute for Health and Clinical Excellence (NICE) introduced a two week referral-to-treatment target on 1st April 2015 stating that more than 50% of people with a first episode of psychosis should be treated with a NICE-approved care package within 2 weeks of referral. In Tower Hamlets, we raised this benchmark to 95%.
In line with the NICE guideline for psychosis (2014), which stated that early intervention services should be accessible to all people irrespective of age or duration of untreated psychosis, THEIS have established a new service for individuals over the age of 35 who are experiencing a first presentation of psychosis. The individual is offered an assessment with a care co-ordinator, clinical psychologist and doctor in the main THEIS team. If they are found to be suitable for our service then they are allocated to one of our over 35s EIS care co-ordinators at their local community mental health team base. They are also offered a package of care including individual and/or family therapy, medication if required, and support with social needs, for example around employment, finances and engaging in the community. They are also offered carers assessments and related support.
Within THEIS, we have a truly team based approach, with a collective leadership model, and benefit from a wide range of disciplines including nurses, doctors, psychologists, social workers, occupational therapists, a bilingual support worker and an employment specialist. Most of our staff are trained in Behavioural Family Intervention, as recommended in the NICE guidelines, and we are able to offer family interventions to all of our clients and their loved ones. Clients are also offered NICE-compliant individual CBT for psychosis, as well as a number of therapeutic groups, which have the added benefit of shared experience communicated between service users, breaking down stigma and isolation.
We take pride in the continuity of care that we are able to offer all clients, from first contact with our service to discharge. We hold clinical responsibility for our service users whether they are in the community or in hospital: this involves care coordinators working closely with the ward staff, and being involved in inpatient care plan development, and the consultant psychiatrist remaining consistent throughout the service user’s recovery journey. We have regular feedback from our service users and their families that the service is valued and supports engagement and recovery. At a recent cross-borough EIS conference, our service users spoke positively about their experiences with THEIS.
Wider Active Support
We have close links with local third sector organisations including The Prince’s Trust, Look Ahead, Tower Hamlets Community Health Trainers, Rethink Family Action, and Urban Yogis. Our Employment Specialist fosters links with local colleges and training providers to increase service users’ access to training and job opportunities and build relationships with local employers to enable our young people to achieve their career goals and reach their full potential.
We hold annual open days for third sector organisations and services users and their families, providing talks and stalls for information and refreshments. We also have regular meetings with our local Child and Adolescent Mental Health Service team to ensure that transition to adult services for young people experiencing psychosis is as smooth and supportive as possible.
All service users and carers are encouraged to complete an experience survey, which includes suggestions for developments. The results are discussed at business meetings, and implementation plans put in place. Service users and carers attend quarterly focus groups to share feedback about experiences of our service and gather ideas for further service development. The team identifies how best to implement developments to follow up the group feedback, and the results are shared with all focus group members.
Several of our service users have completed interview panel training, and have commenced involvement in recruitment of new staff to the team by sitting on interview panels. We have trained more service users this year, and work towards having service users included in recruitment of all new staff. Two of our service users worked with THEIS staff to co-produce our recent Early Intervention Trust-Wide Conference held in Bethnal Green, which was a great success. Service users are also encouraged, as appropriate, to engage with training to become peer support workers, a role which our clients have described as playing a very empowering role in recovery. Our team logo, of which we are very proud, was designed by one of our past service users.
Looking Back/Challenges Faced
We have found service user and carer involvement in developing aspects of our service delivery extremely helpful. We would have preferred to have had input from service users and carers more closely involved in the earlier stages of service design.
It would have been helpful to have started collecting more formal outcome data earlier in the life of the service to demonstrate our effectiveness and identify areas for further improvement in the service to meet the need. This is one lesson we have learned from and we are currently collecting a broad range of outcome data in order to evaluate the effectiveness of our newest development, the THEIS 35+ service.
Working with such a diverse population can present challenges for sharing the model of care, communication, engagement and social integration. We work collaboratively with service users and carers about diverse models of understanding mental distress, so as best to integrate biopsychosocial understandings and care plans. We have several members of staff that speak more than one language and a specialist bilingual support worker to assist with verbal communication. Close relationships with the Tower Hamlets BME Access Service and Spiritual and Cultural Care Service facilitates our awareness of particular culture-bound needs and preferences of groups who we work with. Monthly MDT supervision around family interventions helps to facilitate adaptations for different cultural contexts.
Working as a well-resourced service while other services experience cuts can potentially cause tension between teams; we overcome this by being flexible in our approach and supportive of other teams. We are providing specialist EI supervision to those care co-ordinators in the locality teams who are working with the 35+ service users.
Team members take responsibility for various aspects of the service and the team’s development. We share knowledge and skills in monthly inter-team training and support all staff to develop their interests personally and professionally. For example, we support team members to attend conferences, have specific training in therapeutic models and progress in their professions.
We have embedded the values of teamwork, hope and care into the heart of the team. New starters quickly adopt the culture and we have established a purpose statement as a team to share our vision amongst the teams and to others. Team members are able to and encouraged to present the team ethos and service model to relevant stake holders and forums.
Evaluation (Peer or Academic)
We are evaluated along performance indicators and CQUINS agreed between our Trust and the clinical commissioners on a monthly basis. We are currently meeting the new standards set for referral to treatment time and NICE concordant care for all first episode psychosis patients in our service. We are collecting additional data for the 35+ service in order to learn more about this new client group, for example their route into services and how their difficulties manifest, so that we can continue to develop this service to meet the needs of those presenting for the first time at an older age.
We share our work with others at regular Trust wide Early Intervention meetings. We take a lead in organising and chairing the Trust-wide Early Intervention Conference, in partnership with interested service users. Staff from our team also regularly attend London Early Intervention Network meetings, where we are able to share best practice, research ideas and service developments with other London teams. Members of staff attend national conferences as appropriate to specialties and professions, at which they are able to share our learning more widely via posters and presentations.
Service users are given a welcome booklet when they are taken on by the service, which contains useful information about THEIS, as well as links to other organisations. We also give out contact cards to people being assessed by THEIS and their families, so that information is shared from the very beginning. We have created an Instagram account to share service developments, news and event plans with our service users and their families.
We undertake our own clinical audits of practice and have a number of staff trained in Quality Improvement with QI projects running on improving access and care planning. Our service users deliver outcome feedback after all therapeutic groups and individual or family interventions. Experience feedback is sought on the inpatient wards and via our annual survey.
Is there any other information you would like to add?
Tower Hamlets Early Detection Service have improved engagement and timely support of young people at risk of developing psychosis by going into colleges, third sector youth organisations and faith groups to provide education around mental wellbeing, tackling stigma and encouraging referrals including self or carer referrals.
We are developing new initiatives around technology and social media to improve community engagement, optimise outcomes and improve service user and carer experience.