Children with psychosis should be offered family interventions

Families of children and young people with psychosis or schizophrenia should be offered “at least” 10 sessions of family intervention work, draft guidelines released by the National Institute of Health and Clinical Excellence (Nice) state.

Health and social care professionals should also “consider arts therapies”, including dance, drama, music or art therapy, for all children and young people diagnosed with the mental health conditions, the guidelines recommend.

Family intervention should include the child or young person and be “carried out for between three months and one year” including at least 10 planned sessions, the guidance states.

But it warns that in cases of first episode psychosis, young people and their parents or carers should be informed that “there is little evidence” that psychological interventions alone are “effective without antipsychotic medication.” A time limit of one month or less should be agreed for reviewing treatment options, including introducing antipsychotic medication.

Other recommendations identified in the guidance include:

• When a child or young person experiences transient psychotic symptoms or other experiences suggestive of possible psychosis, they should be referred to a specialist mental health service, such as child and adolescent mental health services (Camhs), “without delay”.
• When a child or young person is referred in crisis they should be seen by specialist mental health secondary care services within four hours of referral.
• Antipsychotic medication should not be offered where psychotic symptoms or mental state changes are not sufficient for a diagnosis of psychosis or schizophrenia. It should also not be offered with the aim of decreasing the risk of psychosis.
• Careful thought should be given to the potential impact on the child and their family before any referral to hospital care is made. This is particularly important where the inpatient unit is a long way from where they live. Consider alternative care in the community “wherever possible”.
• Where applicable, efforts should be made to liase with the child or young person’s school and educational authority to ensure that ongoing education is provided.

The guidance is open for public consultation until 27th September. Social workers can register their views via the British Association of Social Workers or The College of Social Work which are both “registered stakeholder organisations” for the consultation.

Director of the centre for clinical practice at Nice, Professor Mark Baker said:

“This draft guidance issued for public consultation includes a number of recommendations to support healthcare professionals to accurately diagnose psychosis and schizophrenia in children and young people and offer them treatment options that are best suited to them.”

“The guidance also makes clear recommendations on ensuring children and their families or carers have all the information and support they need, encouraging doctors to consider the impact of the diagnosis and treatment,” he added.