Set up to succeed

It might surprise some to learn that there are fewer people with diabetes than those who experience a psychotic episode – a loss of contact with reality which can include disturbing thoughts, delusions or hallucinations.

Usually the first experience will happen to young people aged between 16 and 25, when the prospects for short-term recovery are good. With early intervention and sustained treatment, more than 80 per cent of people overcome the symptoms from their first episode of psychosis within six months. However, traditional services have not been able to offer the required intense support within the community, so specialist early intervention services are springing up nationwide.

Setting up a service can be as challenging as it is exciting, as Alexa Sidwell found upon her appointment as senior manager and project lead for early intervention at NHS South Staffordshire Healthcare. But combining being given the freedom to set up the service with her preferred tools of project management provided a ready mix for success.

“I’ve worked for about 20 years with people with psychoses at different stages of illness and for the last few years I’ve been working with young people with early onset psychosis. So it’s where I’ve been driven clinically,” says Sidwell.

Being new to the organisation was also positive – “it helped having no baggage” – although she had to build credibility around the new service and, indeed, herself. “Every manager should have project management training – it really structures the way you work. So upon arrival in January [2003] I set an agenda for the year mapping out the set activities. The first thing I needed to do was to write the service specification – the vision – and sell that to get organisational support. I spent the first couple of months making presentations wherever I could – management teams, community teams, consultants, nurses, GPs, social services and voluntary agencies,” she says.

With the service vision successfully sold, Sidwell needed to recruit the team to make it happen. And this needed a degree of lateral thinking. “Our service user age range is 14-35. Child and adolescent mental health services (Camhs) don’t have a lot of experience in psychoses; their training isn’t geared up to it as it is quite specialised. Adult services do cover psychoses but they’re not geared up to working with young people. You just can’t get staff who are trained in psychosis and yet are familiar with the youth agenda. So, I recruited psychosis professionals from adult services but allocated two posts for youth workers – and they have been able to drive the youth agenda. They also have strong social care backgrounds and that helps bring in that perspective,” she adds.

Sidwell’s project management mapping had required her to recruit the team by October but to be ready to take caseloads by December – allowing for a two-month induction and training programme. “The organisation and service commissioners know then what to expect. But after a month together there was such a belief within the team that they didn’t want to wait. So we exceeded our target,” she says.

For Sidwell, if a team is to be motivated it needs to be rooted in respect. “When I was on a youth training scheme a ward sister told me that if you always looked after the domestics and porters you’ll be all right in your life. And that’s right. The message is to treat everyone with respect. I want to empower the team – I don’t expect them to automatically agree with me – I want them to feel able to argue and challenge; this service is about making a difference and the team have to feel empowered and supported to do that. Another crucial aspect is getting service user collaboration – indeed one of our youth workers is a service user as well.” she says.

Interestingly, Sidwell has also allocated herself “a small caseload”. She says: “As a manager there is a danger that you get sucked into the culture of performance indicators and so on – which are important – but it’s easy to forget the effect the service you manage has on the individuals who use it; and it’s really refreshing after a round of meetings to go around and see a family. I find it much easier to generate change if you’re leading by example and contributing to the day-to-day work.” CC

Curriculum vitae

Name: Alexa Sidwell.

Job: Senior manager and project lead for early intervention.

Qualifications: Registered mental nurse; BSc psychosocial interventions.

Last job: Project lead for early intervention in Derbyshire.

First job: Health care assistant in a psychiatric hospital, youth training scheme.

Top tips

• Get out and about and be honest and open.  
• Project management can help pace, focus and direct the setting-up of a new service.  
• Set realistic targets and value everyone’s opinions.   

Rubbish tips 

• Don’t let on you don’t know everything. 
• Everything must be done your way.  
• Once you’ve got your budget – work with it and don’t waste time looking for additional resources.