The Early Intervention in Mental Health Network's mission is to improve health and social outcomes for young people with first episode psychosis, including symptom reduction and engagement with education and employment. This document is the beginning of a programme to help people work together in preparation of the regions task to achieve the above mission.

1. Early Intervention Network
South Region Preparedness Programme
@Time4Recovery
#ei2015
12th February 2015

2. AHSN core purpose – health and wealth
• Licensed by NHS England for 5 years to deliver four objectives:
1. Focus on the needs of patients and local populations: support and
work in partnership with commissioners and public health bodies to
identify and address unmet health and social care needs, whilst
promoting health equality and best practice.
2. Speed up adoption of innovation into practice to improve clinical
outcomes and patient experience - support the identification and more
rapid uptake and spread of research evidence and innovation at pace
and scale to improve patient care and local population health.
3. Build a culture of partnership and collaboration: promote
inclusivity, partnership and collaboration to consider and address
local, regional and national priorities.
4. Create wealth through co-development, testing, evaluation and early
adoption and spread of new products and services.

3. Our healthcare, academic and LEP partners
11. South Central Ambulance Service FT 11

4. 4
Early Intervention Network: Our Mission
Improve health and social outcomes
for young people with first episode
psychosis, including symptom reduction
and engagement with education and
employment.

5. 2008 2012 20132009 2010 2011
Started work at EIP +
University of Surrey
Vision Unclear
Noted frequent
Staff turnover
Poor pt satisfaction
Poor staff morale
Poor clinical outcomes
Manager left
Staff posts cut
Staff sickness rocketed
PIER Project
awarded £10,000
(National Leadership Council)
Took up management of team
Began developing a vision
Completed Transformational
Leadership Programme
Reach Out Project
awarded £12,500 Mary
Seacole Award
(DoH)
Youth Mental Health Network
Project (YMHN) awarded £20, 000
for My Journey app (SHA)
Started Proactive
Intervention to Enhance
Recovery (PIER) project
YMHN awarded £35, 000 for
YMH economic evaluation by
LSE (NHS Confed)
After numerous
rejected proposals
My Journey App
awarded £40,000
for evaluation of
clinical, social &
economic impact
(Burdett Trust)
2014
Moyo Project www.moyoacademy.com & www.moyofoundation.org
The Future is Digital
Scoping Project
granted £60, 000
My Journey So Far…

6. www.england.nhs.uk
Components of an effective mental health system
An effective ‘in balance’ mental health system
would:
• Ensure rapid detection of mental ill health
and access to evidence- based treatment in
community settings.
• Provide responsive and compassionate care
to individuals at risk of or in crisis.
• Provide safe, high quality inpatient care
where community alternatives are not viable
• Enable discharge from inpatient care
through provision of personalised packages
of home-based support

7. www.england.nhs.uk
The system is currently not in balance

8. www.england.nhs.uk
There is a 15-20 year gap in the life expectancy of individuals with serious
mental illness compared with the rest of the population
Health promotion activity,
physical health
assessments and
interventions need to be
integrated at every level if
the 15-20 year mortality gap
is to be closed.

9. Why start with psychosis?
9
Rethink Mental Illness. Lost Generation 5
TS AND STATS ABOUT EIP SERVICES
£44MILLIONEACHYEAR
FROM44%
If everyone who was eligible received
early intervention, it would save the NHS
EIP support reduces the probability of someone being ‘sectioned’
EIP support reduces the risk of a young person taking their own life
in the first two months of psychosis
FROMUPTO15%
TO1%
TO23%
Lost Generation Report, Rethink 2014

10. Key Strands of Work
10
1. Bringing together the required expertise National expert reference group, NCCMH ‘hosting’ with
Oxford as lead AHSN, highly collaborative. Regional
implementation steering groups.
2. Developing the required dataset – waiting
times and quality of care
Different approaches for 15/16 and 16/17 and beyond.
Potential use of audit.
Laying the groundwork for other A&W standards
3. Publication of commissioning guidance Service specifications, service model exemplars,
staffing / skill mix calculators etc
4. Design of levers & incentives Planning guidance, payment system development,
standard contract etc. Engagement with Monitor, TDA,
CQC.
5. Implementation support Sponsoring development of peer networks &
accreditations schemes, national events, learning
networks etc.
6. Workforce development Joint work with HEE

11. The Financial Package
11
1. 2014/15 saw a £40 million funding boost for mental health services, securing a kick-start delivery
of the 2020 vision;
2. Building capacity in some priority areas in order to prepare for the introduction of new access
standards in 2015;
3. The package released £7m to CAMHS Tier 4, £33m to EIP and crisis care in 14/15
• £1M for EIP for the South Region in 2014/5
• Plus Four x 200k EIP regional preparedness money in 2014/15
4. A further £80m will be freed in 2015/16 to enable introduction of the first access and waiting
times standards of their kind – lines in the sand – to be set on parity of esteem for mental health;
5. £40m to be targeted recurrently on EIP, £30m on liaison psychiatry and £10m on IAPT

12. Access & Waiting Time Standards
12
By April 2016:
• More than 50% of people experiencing a first episode of psychosis will be
treated with a NICE approved care package within two weeks of referral.

13. 13
Referral to clock start
5
1. Referrer
suspects
first episode
psychosis
(FEP)
2. Urgent /
emergency
referral
made
flagged as
suspected
FEP
Central
triage
point?
3a. Clock
starts when
central
triage point
receives
referral
3b. Clock
starts when
EIP service
receives
referral
Onward
referral to
EIP service
Patient
invited for
EIP
assessment
Y
N
Referral to Treatment (RTT) - Clock Start

14. 14
Referral to Treatment (RTT) - AssessmentAssessment
1. Patient
invited for EIP
assessment
2a.
DNA or
cancella
tion?
3a. Active
monitoring /
watch and
wait
EIP
assessment
commences
2b.
DNA or
cancell
ation?
3b. Active
monitoring /
watch and
wait
EIP
assessment
completed
Y
N
Y
N

15. 15
Assessment to clock stop
7
1. EIP
assessment
completed
FEP?
2a. Clock stops
when:
1. Accepted on to
EIP caseload
2. EIP care
coordinator
allocated
3. NICE
concordant
package of care
commenced.
2b. Clock stops
when:
1. Accepted on to
EIP caseload
2. EIP care
coordinator
allocated
3. Specialist ARMS
assessment
commenced.
3.
ARMS?
Commence
NICE
concordant
package of
care
Onward
referral to
appropriate
service or
discharge
Y
N
Y
N
Referral to Treatment (RTT) - Clock Stop

16. South Region Expert
Reference Group
Inaugural Meeting 26th January 2015
16

17. Regional Preparedness Work
17
1. Raising awareness – What are the requirements of the new standard? What are the
implications? What are the opportunities?
2. Bringing together the experts and establishing quality improvement networks
3. Understanding demand – incidence, incidence profiles etc
4. Understanding the baseline position + gap analysis
5. Optimising RTT pathways – need to engage all of the potential referral sources, many
of which will be internal within secondary care
6. Preparing for the new data collection requirements – training for service and
information leads
7. Developing the workforce – capacity, skills & leadership – can the workforce deliver
the full range of NICE concordant interventions as this will be the definition of ‘treatment’?

18. Purpose of Expert Reference Group (ERG)
18
1. Increase the South regions capacity and capability to deliver the new access
and waiting time standards;
2. Reduce unwarranted variation in workforce competency and outcomes
across the region;
3. Share key messages, lessons learnt and drive for sustainability.

19. ERG Representation:
19
1. Representatives of People with a Lived Experience
2. Subject Matter Experts on Equality, Youth Mental Health, Informatics, Research etc
3. CCG & Social Care Commissioners
4. South Region IRIS Leads
5. Strategic Clinical Networks
6. Provider Senior and Team Level Managers
7. Health Education England
8. NHS England (South)
9. Wessex, Oxford and South West AHSN
10.Programme Managers

20. Benchmarking Staff Capacity & Competency
20
South Region
Survey Deadline: 19th Jan 2015

21. Deliverables
21
1. A report on current EIP staff provision and training gap analysis against the
new EIP access and waiting time standards;
2. A proposal detailing funding allocation, monitoring and reporting
arrangements;
3. Sign off of bi-Monthly progress reports on delivery which will feedback to
NHS England.

22. Big Data: What can the Unstructured & Structured Data Tell Us?
22
~80% of clinical data on EPRs is uncoded/unstructured

23. Draft Analysis of Needs of People with
Psychosis in Oxford AHSN Region
(Using Structured Reported Data)
Focus on Early Intervention
December 2014

24. Identifying the Early Intervention Cohort
24
Team Type = A14 in 2011-13
= 05 in 2010-11
All those having
some interaction
with the Early
Intervention team in
2010-13 (3 yrs)
Psychosis
3 years
58,133
15,709
(27%)
Other MH 42,424
Psychosis
3 years
1,344
986
(73%)
167
Unknown
Other MH
191
Source: Oxford AHSN user data contained in HES and MHMDS datasets licensed
from HSCIC, 2014

25. Comparison of Education, Employment Status
7%
19%
18%
15%
10%
4%
7%15%
36%
33%
48%41%
37%
11%
18%23%
100%
Other
mental
health,
16-35
5,722
10%
Psychosis,
Other Age
Groups
7,068
4%
34%
Psychosis,
Other
teams,
16-35
2,747
8%
Psychosis,
Early
Intervention,
16-35
785
7%
Latest across 2 years 2011-12 and 2012-13; Not all service users have Employment status recorded;
16-35 cohort identified by age in 2010-11
Employed
Unemployed and seeking work
Students in full-/part-time education
Long-term sick/disabled, on benefits
Unknown/Retired
Source: Oxford AHSN user data contained in HES and MHMDS datasets licensed
from HSCIC, 2014
25

26. 26
+8%
Users without known
mental health issues,
16-35yr group
131,244123,567112,696
1,0871,103976
+6%
Users with psychosis,
Other teams only,
16-35yr group
357362310
+7%
Early Intervention
cohort, 16-35yr group
2012-132011-122010-11
1.41.41.4
+2%
2.92.82.7
+3%
1.92.12.0
2012-132011-122010-11
-2%
Total users Average per user
+100%
-35%
Source: Oxford AHSN user data contained in HES and MHMDS datasets licensed
from HSCIC, 2014
16-35
years
only
Early Intervention cohort has fewer A&E attendances

27. Examples from the South Region
27

28. 28
Patient Journey Mapping

29. 29
18
Describing digital maturity
Self-help & peer support
Self-management and remote triage
Remote care support
Face-to-face care
VCS Statutory Care
Against a traditional clinical perspective
Stage 0 Stage 1 Stage 2 Stage 3 Stage 4
General access to
information
Sign-posting to
offline services
Health
administration –
reminders,
appointments,
prescriptions
Remote service
support to assess
and diagnose
symptoms and
conditions
Advanced remote
service support to
provide care
support and
treatment
Multichannel care
services leveraging
a digital core for
optimal access and
data sharing
Thriving Coping Managing Difficulties Struggling Complex needs
Along a trajectory of evolving digital capability
Along a care trajectory marking the transition between statutory and
VCS and the shift from self-service to highly skilled face-to-face support
Crisis
Digitally Enhanced Pathways

31. 31
Engaging young people with familiar tools
92% of 14-25 year olds
own a smartphone
Sensors, devices, networks,
software, sensors
and data

32. 32
Engaging Using Multiple Channels

33. 33
Measuring Reach & Engagement

34. 34
Number of people
reached during this
masterclass

35. Opportunity, Meet Preparation.
35
My Journey App - The First International App for First Episode Psychosis
Videos Viewable by Clicking Here

37. 37
http://www.berkshirehealthcare.nhs.uk/beds/

38. 38
www.sabp.nhs.uk/eiip
Health Promotion

39. 39
http://www.psfk.com/2014/12/code-blue-panic-button-aims-to-help-teens-with-depression.html

40. 40
http://oxtext.psych.ox.ac.uk/true-colours

41. 41
Who is Using MOMO
• Surrey County Council
• Derbyshire County Council
• West Sussex County Council
• South Eastern Trust (Northern Ireland)
• Northumberland County Council
• Reading Borough Council
• London Borough of Bexley
• Royal Borough of Greenwich
• Birmingham City Council
• Gloucestershire County Council
• More local authorities on the way...
http://www.mindofmyown.org.uk

42. Sir Muir Gray
42
“In the past we have given knowledge to clinicians who
have passed it on to patients, now our principles are that
we give knowledge to patients and give them the
opportunity to discuss it with clinicians.”

43. 43
http://www.computerworlduk.com/news/public-sector/3524196/oxford-nhs-trust-creates-mobile-electronic-health-records-with-advanced/

44. 44
Videos Viewable by Clicking Here

45. 45
Learning from Developing Countries
Community Health Worker/Ambassador Model for Community Dev.

46. Community Health Ambassadors should be members of the
communities where they live, work, study, play… should be
selected by their communities, should be answerable to the
communities for their activities, should be supported by the
health system but not necessarily a part of its organization,
and have shorter training than professional workers.
World Health Organization
(2007)
“
”
Community Health Ambassadors (CHAs)

47. 47
www.itsgoodtochat.com

50. 50
www.itsgoodtochat.com

51. Six Characteristics of Effective Groups
51
1.They share a sense of Purpose: There is purposefulness about their collaborations, discussions,
decisions and a sense of forward momentum;
2.They are United: They have learned to manage their differences well enough that they can unite to
accomplish their purpose;
3.They share Understanding: There is a widely shared understanding of whats going on, what the
challenges are and why what is being done has to be done;
4.People Participate: Lots of people and organisations in the system are active - not just in discussions
and meetings - but getting the work done;
5.They take Initiative: Rather than reacting to what ever happens in their environment, they are
proactive, and act upon their environment;
6.They Act: People do the work they must do to make the things happen that need to happen.

52. 52
Harnessing Digital Tools for Collaboration Across the Region

53. 53
An intelligent system that gets to know you
www.interact-intranet.com

54. 54

55. 55

56. 56

57. 57

58. Collaboration: Anytime, anywhere
58
• Secure log in using your existing email,
• Multi location configuration i.e we can set it so that different groups have different access rights &
content to other members dependent on their locations
• Meeting planning including ability to export confirmed attendees into an attendee list,
• Task allocation and tracking,
• Event scheduling and team based calendars including ability for people to book on to training
events/webinars;
• Expense claim submissions (e.g. for travel expenses),
• Document view, multi-user editing and version control,
• Mandatory document read settings with ability to send reminders if people haven’t Read
mandatory read documents;
• Analysis of users use of the platform so we can measure ROI and terminate use if not being used;

59. Challenges for Us
59
• Divestment in mental health services put pressures on a system which was already failing to
reach all of those who need it;
• Access to existing services or lack of existing services
•Acceptability and stigma
•Visibility of services
•Capacity
• Variable team structures, leadership, management, training etc leads to unwarranted variation in
processes, methods and outcomes;
• Inappropriate and varying referral thresholds, practices and reporting leave the user often as the
last consideration.

60. What should you and I expect?
60
1.Collaboration
2.Ideas
3.Action
4.Innovation
5.Sustainability
I also expect that we will:
•Make mistakes
•Tread on toes
•Feel uncertain and a bit threatened

61. 61
https://www.eventbrite.com/e/early-intervention-network-achieving-better-access-to-mental-health-services-by-2020-tickets-15022846739?
utm_campaign=order_confirm&utm_medium=email&ref=eemailordconf&utm_source=eb_email&utm_term=eventnameTickets:

62. 62
http://us2.campaign-archive2.com/home/?u=ab247a6ad6b0e2d93ab084c28&id=a09b7f2250Monthly Newsletter:

63. In Summary
63
•We have many of the required component parts;
•We have the mandate, top as well as bottom level support;
•Our stakeholders want/expect us to do this responsibly and to
the best of our abilities for sustainable, best value;
•We will not get this opportunity again.

64. Thank You
Q & A
More Information Available on Request
belinda.lennox@psych.ox.ac.uk
sarah.amani@earlintervention.oxfordahsn.org
@Time4Recovery
#ei2015
64