Early Intervention in Psychosis Services (EIPS)

Early Intervention in Psychosis Services (EIPS) provide specialist support to individuals experiencing a first episode of psychosis and offer psychosocial, pharmacological and vocational interventions for up to three years. In comparison to routine care provided by Community Mental Health Teams, EIPS have been found to improve outcomes for individuals while accessing these services, such as reducing psychiatric inpatient admissions and enhancing psychosocial functioning and quality of life (Craig et al., 2004; Turner, Boden, Smith-Hamel, & Mulder, 2009). However, these social and clinical gains frequently diminish following discharge from EIPS and improved outcomes are no longer detected five years after leaving these services (Gafoor et al., 2010; Bertelsen et al., 2008). Previous investigations have found that many individuals subsequently experience a relapse in symptoms requiring an inpatient admission and that the first year following discharge is the highest risk period for relapse (Kam, Singh, & Upthegrove, 2015; Puntis, Oke, & Lennox, 2018). This suggests that enhancing socially-focused support throughout the processes of discharge and transition to primary care or secondary mental health services could enable individuals to maintain recovery after EIPS.

The risk of relapse following discharge from EIPS is of particular concern, due to the profound social detriment of disruptions to employment, education and personal relationships to the lives of vulnerable individuals, and the reduced potential for sustained recovery caused by each relapse in psychosis (Álvarez-Jiménez, Parker, Hetrick, McGorry, & Gleeson, 2011). Previous research has identified some risk factors for relapse following discharge from EIPS, such as living in a socially deprived area and a history of substance misuse (Puntis et al., 2018). However, these studies are limited in number and there has been insufficient focus on identifying groups of individuals at highest risk of relapse, for whom increased support might be most crucial. Expoloration of the experiences of discharge and transition from EIPS is also scarce within the qualitative literature, in spite of the explanations this could offer for the frequent reductions in well-being observed after EIPS. Lester et al., (2012) found that individuals leaving EIPS and entering primary care perceived the tranisition more favourably when discharge was planned and often struggled to adapt to the loss of holistic support provided by EIPS. This strengthens the case for targeting supportive interventions to the processes of discharge and transtion.

An increased research focus on improving support to individuals leaving EIPS has been called for (Kam et al., 2015) since there are currently no evidence-based approaches for reducing relapse or supporting individuals to maintain improvements to social and personal functioning after leaving these services. Therefore, the proposed project will address this research gap, through providing an evidence-base to inform a psychosocial intervention to support individuals who have accessed EIPS to maintain recovery. This will be achieved through investigating further potential risk factors for relapse after EIPS, in order to expand on previous research and to identify those at highest risk, to ensure the intervention is tailored to the needs of those most vulnerable to relapse. The evidence base will also be developed through investigating the lived experience of discharge and transition from EIPS from the perspectives of individuals who use these services and the facilitators and barriers to maintaining recovery throughout these processes. This will build on the limited existing literature through including those who are discharged to both primary and secondary care destinations, in addition to including the perspective of the mental health practitioners who support them, to identify means of optimising support to individuals throughout these processes.