Rising caseloads and cuts hit acclaimed early intervention psychosis services

Early intervention teams supporting teenagers and young adults with psychosis are being beset by budget and staffing cuts despite government praise for the ‘internationally recognised’ services, research shows.

A survey of 96 of 125 early intervention psychosis services (EIP) in England revealed that 50% had seen their budgets cut in the last year. More than half of EIP services had lost staff (58%) and almost a third (31%) said that their caseloads had exceeded recommended levels. Some teams had been disbanded entirely, while others had seen their functions absorbed into community mental health teams.

The survey was carried out by mental health charity Rethink mental illness and the IRIS network, a group of professionals that support early intervention work.

EIP teams support 14 to 35-year-olds to recover from a first episode of psychosis through interventions including family therapy and employment support. The EIP model is praised as an example of ‘internationally recognised’ care in the government’s mental health strategy. Research has suggested the services could save the NHS up to £44 million a year by cutting pressure on hospital beds.

Jane Hughes, director of campaigns at Rethink, said that the cuts to EIP teams were leading to young people facing “unacceptable waits” for care, increasing the likelihood of them requiring hospital admission or detention under the Mental Health Act.

“That’s why cutting early intervention care makes no sense whatsoever. The human, social and economic costs of are too great, especially at a time when mental health hospitals are completely over-stretched and unable to cope with demand,” she said.

Faye Wilson, chair of the British Association of Social Workers’ mental health forum, said EIP services had “one of the strongest evidence bases for early intervention”.

“It’s appalling to cut these services. They have been incredibly effective in supporting people’s recovery. As well as working with people around their psychosis, they have done incredible work around things like supporting people back into employment and education,” she said.

Wilson said moves to absorb EIP teams into generic community mental health teams risked losing the benefits of intensive support.

“Community mental health teams are often running caseloads of 30 or 35 per worker. The recommended caseload for EIP is around 12. With 12 cases you can respond intensively, you can take that whole team and whole life approach and work with support workers to link people into community facilities,” she said.

The Rethink report report makes a series of recommendations to improve care, including a call on the government to introduce a maximum waiting time of 28 days for accessing EIP services.

Responding to the findings, a Department of Health spokeswoman said: “It’s completely wrong to disadvantage mental health when allocating local funds. We are clear that the NHS must place equal priority on physical and mental health – decisions on how to spend NHS money should reflect this.

“Mental health is a priority for this Government which is why we have invested over £450 million into improving access to treatment for people with mental health problems. We are also improving care for people in crisis, setting up ‘street triage’ pilots across the country, investing £25m in liaison and diversion services and asking NHS England to introduce waiting time standards for mental health.”