Skip to main content

Advertisement

SpringerLink
Log in

Routine evaluation in first episode psychosis services: feasibility and results from the MiData project

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

Early intervention services (EIS) for psychosis are becoming widespread. Structured methods of assessment are advocated in these services, but a consensus is still needed on a package of measures with good psychometric properties that is feasible and reliable for routine use in this setting.

Methods

A computerised assessment package (MiData) was designed to provide clinicians with easy-to-understand feedback about clients’ progress and to allow evaluation of the whole service for both audit and research purposes. Core areas include symptoms, duration of untreated psychosis (DUP), pathways into care, social functioning, and substance misuse at initial intake and annually thereafter.

Results

MiData has been adopted by EIS throughout London and in some other centres. Baseline data are now available regarding 533 first-episode psychosis patients who presented to 8 London teams. The completeness of the data varied across teams and measures, with fullest completion for sociodemographic data (99% on some measures) and poorest for DUP. The average London EIS client is male, single, unemployed and comes from Black or Minority Ethnic group. Most (70%) demonstrated poor social functioning at intake, over a third (38%) reported substance abuse problems and 23% had harmed themselves or others in the previous 6 months.

Conclusions

MiData provides a clinician-friendly system of evaluating first-episode psychosis services but requires further refinement and dedicated resources to improve completion rates. This method of collecting routine data is of use to clinicians, managers, health service researchers and commissioners and potentially it may enable naturalistic comparisons between different models of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Barnes TR, Mutsatsa SH, Hutton SB, Watt HC, Joyce EM (2006) Comorbid substance use and age at onset of schizophrenia. Br J Psychiatry 188:237–242

    Article  PubMed  Google Scholar 

  2. Department of Health (2000) The NHS plan: a plan for investment, a plan for reform. Department of Health, London

    Google Scholar 

  3. Department of Health (2001) The mental health policy implementation guide. Department of Health, London

    Google Scholar 

  4. Department of Health (2005) Delivering race equality in mental health care. Department of Health, London

    Google Scholar 

  5. Department of Health (2006) Back into work, back into society: more social inclusion for people with mental health problems. Department of Health, London

    Google Scholar 

  6. Drake RE, Mueser KT, McHugo GJ (1996) Clinician rating scales: alcohol use scale (AUS), drug use scale (DUS), and substance abuse treatment scale (SATS). In: Sederer LI, Dickery B (eds) Outcomes assessment in clinical practice. Williams & Wilkins, Baltimore, pp 113–116

    Google Scholar 

  7. Endicott J, Spitzer RL, Fleiss JL, Cohen J (1976) The global assessment scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33(6):766–771

    PubMed  CAS  Google Scholar 

  8. Garety PA, Craig TK, Dunn G, Fornells-Ambrojo M, Colbert S, Rahaman N, Read J, Power P (2006) Specialised care for early psychosis: symptoms, social functioning and patient satisfaction: randomised controlled trial. Br J Psychiatry 188:37–45

    Article  PubMed  Google Scholar 

  9. Gilbody S, House A, Sheldon T (2002) Psychiatrists do not use outcome measures. Br J Psychiatry 180:101–103

    Article  PubMed  Google Scholar 

  10. Gilbody SM, House AO, Sheldon TA (2002) Outcomes research in mental health. Br J Psychiatry 181:8–16

    Article  PubMed  Google Scholar 

  11. Harvey CA, Jeffreys SE, McNaught AS, Blizard RA, King MB (2007) The Camden Schizophrenia surveys. III: Five-year outcome of a sample of individuals from a prevalence survey and the importance of social relationships. Int J Soc Psychiatry 53(4):340–356

    Article  PubMed  Google Scholar 

  12. Kay SR, Opler LA, Fiszbein A (1992) Positive and negative syndrome scale (PANSS): manual. Multi-Health Systems, Inc., New York

    Google Scholar 

  13. Leucht S, Kane JM, Kissling W, Harman J, Etschel E, Engel RR (2005) What does the PANSS mean? Schizophr Res 79:231–238

    Article  PubMed  Google Scholar 

  14. Lindenmayer JP, Grochowski S, Hyman RB (1995) Five factor model of schizophrenia: replication across samples. Schizophr Res 14(3):229–234

    Article  PubMed  CAS  Google Scholar 

  15. Malla A, Norman R, Scholten D, Manchanda R, McLean T (2005) A community intervention for early identification of first episode psychosis: impact on duration of untreated psychosis (DUP) and patient characteristics. Soc Psychiatry Psychiatr Epidemiol 40(5):337–344

    Article  PubMed  Google Scholar 

  16. Marshall M, Lockwood A, Lewis S, Fiander M (2004) Essential elements of an early intervention service: the opinion of expert clinicians. BMC Psychiatry 4:17

    Article  PubMed  Google Scholar 

  17. National Institute for Mental Health Evaluation (2005) Minimum fidelity standards for new EIP services. NIMHE, North East, Yorkshire and Humber, UK

  18. Overall JE, Gorham DR (1988). The brief psychiatric rating scale (BPRS): recent developments in ascertainment and scaling. Psychopharmacol Bull 24:97–99

    Google Scholar 

  19. Platz C, Umbricht DS, Cattapan-Ludewig K, Dvorsky D, Arbach D, Brenner HD, Simon AE (2006) Help-seeking pathways in early psychosis. Soc Psychiatry Psychiatr Epidemiol 41(12): 967–974

    Article  PubMed  Google Scholar 

  20. Preston NJ, Stirling ML, Perera K, Bell RJ, Harrison TJ, Whitworth L, Castle DJ (2003) A statewide evaluation system for early psychosis. Aust N Z J Psychiatry 37:421–428

    Article  PubMed  Google Scholar 

  21. Priebe S, McCabe R, Bullenkamp J, Hansson L, Rossler W, Torres-Gonzalez E, Wiersma D (2002) The impact of routine outcome measurement on treatment processes in community mental health care: approach and methods of the MECCA study. Epidemiol Psichiatr Soc 11(3): 198–205

    PubMed  Google Scholar 

  22. Rosenheck RA, Fontanna A, Stolar M (1999) Assessing quality of care: administrative indicators and clinical outcomes in post traumatic stress disorder. Med Care 37:180–188

    Article  PubMed  CAS  Google Scholar 

  23. Salokangas RKR (1997) Living situation, social network and outcome in schizophrenia: a five-year prospective follow-up study. Acta Psychiatr Scand 96:459–468

    Article  PubMed  CAS  Google Scholar 

  24. Singh SP, Cooper J, Fisher HL, Tarrant CJ, Lloyd T, Banjo J, Corfe S, Jones P (2005) Determining the chronology and components of psychosis onset: the Nottingham Onset Schedule (NOS). Schizophr Res 80(1):117–130

    Article  PubMed  Google Scholar 

  25. Singh SP, Fisher HL (2005) Early intervention in psychosis: obstacles and opportunities. Adv Psychiatr Treat 11:71–78

    Article  Google Scholar 

  26. Tait L, Birchwood M, Trower P (2002) A new scale (SES) to measure engagement with community mental health services. J Mental Health 11(2):191–198

    Article  Google Scholar 

  27. Thornicroft G, Slade M (2000) Are routine outcome measures feasible in mental health? Qual Health Care 9(2):84

    Article  PubMed  CAS  Google Scholar 

  28. Thorup A, Petersen L, Jeppesen P, Øhlenschlaeger J, Christensen T, Krarup G, JØrgensen P, Nordentoft M (2006) Social network among young adults with first-episode schizophrenia spectrum disorders: results from the Danish OPUS trial. Soc Psychiatry Psychiatr Epidemiol 41:761–770

    Article  PubMed  Google Scholar 

  29. Young RC, Biggs JT, Ziegler VE, Meyer DA (1978) A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 133:429-435

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work is supported by the London Development Centre for Mental Health. Initial pilot work within Camden and Islington EIS was supported by Islington PCT. We are extremely grateful to clinicians and patients from the participating teams for their time and enthusiasm. We would particularly like to acknowledge the contributions of Tom Grange, Katharine McLoughlin, Kelso Cratsley, Laurence Church, Barny Major, Rhianne Doherty, Sasha Gold, Denise Bevan, Lisa Gaiotto, Peter Bailey, Jana Advani, Teuta Rexhepi, Charlie Heriot-Maitland and Mima Simic to collection of data in the individual sites. Thanks also go to members of LEIRN, especially Swaran Singh, Aurelie Freeman, Gillian Paul, Emma Stinton and Jim O’Donnell for their contributions to the development and implementation of the package.

Author information

Authors and Affiliations

  1. Institute of Psychiatry, PO80 MRC SGDP Centre, De Crespigny Park, London, SE5 8AF, UK

    Helen Fisher

  2. Dept. of Psychology, Royal Holloway University of London, Egham, Surrey, UK

    Kate Theodore

  3. Lambeth Early Onset Service, South London and Maudsley NHS Foundation Trust, Lambeth Hospital, London, UK

    Paddy Power

  4. ETHOS, Springfield Hospital, London, UK

    Brock Chisholm

  5. STEP, London, UK

    Jo Fuller

  6. THEIS, St Clement’s Hospital, London, UK

    Karl Marlowe

  7. COAST, Westways Resource Centre, West Croydon, UK

    Katherine J. Aitchison

  8. KCW EIS, Paterson Centre for Mental Health, London, UK

    Raj Tanna

  9. Lewisham EIS, London, UK

    John Joyce

  10. EQUIP, City and Hackney Centre for Mental Health, London, UK

    Maxine Sacks

  11. PO33 David Goldberg Centre, Institute of Psychiatry, De Crespigny Park, London, UK

    Thomas Craig

  12. Dept. of Mental Health Sciences, University College London, London, UK

    Sonia Johnson

Authors
  1. Helen Fisher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kate Theodore
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paddy Power
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brock Chisholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jo Fuller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karl Marlowe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Katherine J. Aitchison
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Raj Tanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. John Joyce
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Maxine Sacks
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Thomas Craig
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sonia Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helen Fisher.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fisher, H., Theodore, K., Power, P. et al. Routine evaluation in first episode psychosis services: feasibility and results from the MiData project. Soc Psychiat Epidemiol 43, 960–967 (2008). https://doi.org/10.1007/s00127-008-0386-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-008-0386-1

Keywords

Search

Navigation