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, (i.e. 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.

Emily was distraught when EIP services said they couldn’st help her. She was self-harming, hearing voices and facing homelessness when her psychologist helped her to get admitted to hospital.

Age at interview 23

Gender Female

Age at diagnosis 21

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Joe’s school counsellor quickly referred him to EIP when he said he was hearing voices. But he then had two weeks seeing lots of different people before he started getting help.

Age at interview 23

Gender Male

Age at diagnosis 21

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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.

Dominic called 999 after he had a psychotic experience and was taken to see his GP. When he told her about the voices that everyone hears she explained that not everyone hears voices.

Age at interview 24

Gender Male

Age at diagnosis 21

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Andrew X knew something was wrong but didn’st know it was mental health. He was petrified when he was first given a Mental Health assessment.

Age at interview 24

Gender Male

Age at diagnosis 14

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Peter hasn’st told anyone about his experiences of psychosis. He doesn’st feel he could explain his complex experience to his GP in a 10 minute appointment and anyway doesn’st want to take medicine.

Age at interview 24

Gender Male

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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.

When Ruby started hearing voices she was already seeing mental health services. Staff told her to just get on with it and her GP referred her for talking therapy. Things got worse and she ended up in hospital being assessed by a crisis team.

Age at interview 22

Gender Female

Age at diagnosis 19

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Nikki was referred to CAMHS by her GP, but was told she wasn’st severe enough to get their support. It was only when her school counsellor referred her again that they realised she needed help.

Age at interview 19

Gender Female

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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.

When Nikki was 17 she was discharged from CAMHS and when she needed support six months later she was just under 18 and was told they couldn’st support her or refer her to adult services.

Age at interview 19

Gender Female

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Andrew X had a great commissioning agreement when he was with CAMHS and EIP and was supported at home. But when he turned 18 he was transferred to adult services and all the support was gone, overnight.

Age at interview 24

Gender Male

Age at diagnosis 14

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Some were transferred to EIP to receive more specialist support for psychosis.

Hannah was transferred from CAMHS, who she had been seeing for low mood, to EIP. There was a gap of about 4 months when she had no support because EIP were understaffed.

Age at interview 19

Gender Female

Age at diagnosis 15

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When Sam was switched from CAMHS to EIP to access more specialised staff, she was assigned a CPN (Community Psychiatric Nurse) who didn’st turn up to meetings. It was some time before Sam had a CPN she got on with.

Age at interview 18

Gender Female

Age at diagnosis 17

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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’.

Sameeha remembers being referred to EIP after her discharge from hospital. She didn’st feel she needed further support but it was some time before they discharged her.

Age at interview 22

Gender Female

Age at diagnosis 21

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EIP have struggled to support Lucy. She was referred to them by CMHT, but EIP are referring her back again because they’sre not sure how to help. She feels she is being passed on.

Age at interview 22

Gender Female

Age at diagnosis 21

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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’.

Green Lettuce had different members of a mental health team visit him at first.

Age at interview 25

Gender Male

Age at diagnosis 20

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The crisis team came to see Tariq every day at home, and when he needed time away from his family he could go to a respite unit.

Age at interview 21

Gender Male

Age at diagnosis 18

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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’.

Luke compares the support he gets from his CPN, who is brilliant with his psychiatrist and GP.

Age at interview 21

Gender Male

Age at diagnosis 19

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Joseph had visits from a Community mental health team. They did a wrap plan’s with him to get some routine into his life, but what he found most helpful was just being able to chat like he would to a friend.

Age at interview 22

Gender Male

Age at diagnosis 21

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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’.

Dominic thinks people who work in mental health should be passionate about it.

Age at interview 24

Gender Male

Age at diagnosis 21

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Fran said there are good ones, amazing ones and some who don’st give a damn. She appreciated people who showed empathy and recognised she was unwell.

Gender Female

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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.

Mental health services told Ruby we don’st want you back because she was self-harming. Ruby has a good care coordinator now who has worked with her before when she was diagnosed with Borderline Personality Disorder.

Age at interview 22

Gender Female

Age at diagnosis 19

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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.

Tariq has a good relationship with his psychiatrist and mental health nurse. They let him set out his own care plan and treated him while he lived at home rather than sectioning him despite his own family’s concerns.

Age at interview 21

Gender Male

Age at diagnosis 18

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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).

Getting help in a crisis

Many people had only received help when their psychosis had reached crisis point - i.e. they felt unable to cope or control things. This could...