Psychosis (young people)

Support from GPs and mental health services

People who experience psychosis can receive treatment and support from their GP and mental health services as an outpatient. You can read elsewhere about receiving care in hospital. There are a number of different teams who provide outpatient services:
  • CAMHS – Child and Adolescent Mental Health Services who see people aged 17 and below
  • CMHT – Community Mental Health Teams who see people age 18 and over, and have Crisis teams
  • EIS (or EIP) – Early Intervention Services (or Early Intervention in Psychosis) who see people within the first 3 years of their first psychotic experience
Typically people who experience psychosis receive some support through an Early Intervention Service (EIS) – sometimes known as Early Intervention in Psychosis (EIP) teams. EIS see many young people who are experiencing distress and have been experiencing psychosis. Research has shown that people who experience psychosis and receive support and treatment quickly respond better to that treatment and recover more fully in the long term. EIS services want to get people into treatment as soon as possible, for example within weeks of the psychotic experience. When someone is referred to EIS, an initial assessment is carried out to see whether the person fits the criteria for support, for example, whether symptoms are regular and severe enough for the person to be assisted by EIS.
EIS offer a wide range of support and can refer people onto other services. Dominic said, “Most of the support I've had has been from EIP. They are an actual NHS organisation. But they worked with a lot of other foundations, a lot of other people. They are the ones who got me into my CBT groups, which were just fantastic. They're the ones that got me into the charity event days.” (See support groups).
 
First contact with mental health services
 
There was no single route into mental health service support and some saw a variety of health service providers before they got the help they needed with their psychosis. Many people saw a school counsellor or GP for help initially, and some went to A&E or called emergency services. Some of the young people had been receiving help with their mental health long before their first experience of psychosis, for example due to low mood or other health experiences. Luke began seeing a counsellor when he was 12 and Andrew Z, was given a diagnosis of Asperger’s Syndrome during his childhood and saw a psychotherapist. Hannah and Sam were already seeing CAMHS for low mood and depression when they had their first experiences of psychosis. Mental health teams could link people into other services and support networks. See getting help in the early stages
 
Making first contact could be daunting and often happened at a time when psychotic experiences were at their worst.
A few people felt that particular medical professionals did not take them seriously when they sought help as outpatients or in hospital and some felt there was a stigma against mental health service users in the NHS. Nikki, who is training to be a mental health nurse, said she experienced stigma within the NHS service because of her mental health. Tariq also felt strongly that stigma against mental health existed and felt it was more noticeable than racial discrimination. You can read more about what people said about facing stigma here.
Gaps in support from mental health services
 
When people accessed mental health services they were positive about the support they received. Luke had “pretty much nothing but good things to say about them”. Andrew X thinks he’d be dead without some of the support he’s had. But for some there had been periods when support was not available, such as when moving between services like CAMHS to EIP or from CAMHS to adult CMHT. Moving between services was often unsatisfactory with gaps when support was poor or unavailable altogether.
 
A few transferred between CAMHS and adult services when they turned 18.
Some were transferred to EIP to receive more specialist support for psychosis.
Being discharged 
 
Most of the people we spoke to were still receiving support from CMHT or EIP, but a few were not. Sameeha and Joseph had a single, brief (2 – 4 weeks) period of mental illness including psychosis and felt recovered. Hannah was no longer supported by EIP and saw her GP about her medication. Joe and Ruby had been discharged from adult mental health services but still wanted their help because they were still unwell. Ruby was told she was discharged because they had “run out of options”.
Receiving support from mental health staff
 
People talked about different staff who they had contact with, including: 
  • GPs
  • GP reception staff
  • Psychiatrists
  • Mental health nurses (also Community Psychiatric Nurse (CPN)
  • Occupational therapists
  • Psychologists
  • Care coordinators 
  • Social workers
 
Mental health (MH) staff supported people in a number of ways: prescribing medication; referring people for talking therapy; finding accommodation; and helping people to manage their day-to-day lives by getting into a routine and setting goals. People were seen by GPs and MH staff in hospital, mental health outpatient centres or at home. Chapman goes to his local mental health centre regularly for treatment and has a social worker visit him at home. Fran’s social worker helps her with her medication and “has a chat and a cup of tea and goes again”.
For most it was the people who saw them regularly, and who they could “chat” to, who had the biggest impact. While Andrew X remembers “inspirational” and “poor” practitioners, it was people who he could “banter” with when he was unwell who made the most difference to him. People sometimes didn’t know the official title for those with support roles who helped them most, and referred to them as “carers”, “caseworkers” or “social workers”.
People valued professionals who were understanding, sensitive and willing to listen, able to show empathy and care and to think about the person as an individual. This included psychiatrists, social workers and CPNs but also administrative staff such as NHS phone line operators and GP receptionists. A few people said that GP reception staff had been unhelpful, unthoughtful or unkind. A GP receptionist made Becky cry in the waiting room because she was asking so many personal questions and Becky knew people were listening. 
 
Several people had encountered members of staff who didn’t seem to care. Some staff treated Andrew X like he was “just another problem case” and he couldn’t understand why they were working in mental health. Sam had a psychiatrist who took “the mick” out of her asking “so you seeing anything now… is the chair talking to you?” and telling her “it’s just anxiety”.
When people had a change of care coordinator, GP or therapist it could be frustrating having to retell their story again and again. Hannah would like teams to pass on sufficient information to avoid this happening. Finding someone who they got on with and who was willing to work with them, potentially for several years, could make a big difference.
Good staff could make a huge impact and could help people regain a sense of control over their own life. Fran described her community psychiatric nurse as “one of the greatest people” in her life. She says she wouldn’t be doing the things she does now without her encouragement.
Some of the people we spoke to were over 18 when they had sought help and received support from adult services. Some had started receiving support when they were 17 or under and were assessed by CAMHS. Nikki found CAMHS staff could be “patronising”. She was upset that they had told her father “absolutely everything” and she felt she couldn’t trust them and talk about what had “actually happened” in her life (e.g. when she’d taken drugs).

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