Implications of the EXTEND study
Early Intervention in Psychosis (EIP) services provide crucial community-based treatment and support to people during their first episode of psychosis, at a pivotal moment in their lives.
Our policy briefing, Early intervention in psychosis services: implications of the EXTEND study, sets out the findings of research into what works in early intervention in psychosis care, and what these findings mean for national policy and local commissioning. The research was conducted through the EXTEND study, a multi-centre study funded by the National Institute for Health and Care Research (NIHR).
The briefing finds that EIP services that offer the full range of interventions recommended in NICE guidance, including talking therapies, medication, family interventions, employment support and physical health care, provide a better experience and produce better outcomes for the people who use them. Keeping care coordinators’ caseloads to 15 or fewer is also strongly associated with better outcomes.
The research finds that people from racialised communities have worse outcomes from EIP services, including higher rates of restrictive interventions such as admission to a psychiatric intensive care unit and physical restraint. This reflects deeply entrenched racial inequities in both wider society and the NHS.
Most people are discharged from EIP services after around three years, either to a community mental health team or to general practice. The briefing finds that the quality of this transition is crucial to people’s longer-term outcomes, and that some people feel abandoned when a move on is rushed or based on an arbitrary cut-off rather than their individual needs.
The briefing calls for the Government’s forthcoming Modern Service Framework for severe mental illness to set out clear expectations that EIP services must provide the full range of interventions, maintain caseloads of 15 or fewer for each care coordinator, and ensure that decisions to move someone on from EIP are based on their needs.
It also calls on the Department of Health and Social Care to ensure that the Patient and Carer Race Equality Framework is sustained and fully resourced.
