This document summarizes a presentation on extending early intervention services to additional mental health conditions beyond psychosis. It discusses how early intervention aims to improve outcomes by promptly starting effective treatments and providing intensive support. The network's priorities are outlined, which include identifying conditions early in adolescence/early adulthood where early intervention may be effective. Obsessive compulsive disorder is provided as an example condition that meets the priorities, as evidence demonstrates it often has onset in young people, can become severe and enduring without treatment, and responses well to early interventions. The case is also made for early intervention in anorexia nervosa based on evidence that outcomes are better when treatment is provided within the first three years.
Kevin W. O'Neil, MD, FACP, CMD and Chief Medical Officer of Internal Medicine and Geriatrics reviews how to navigate the intricacies of substance abuse in older adults.
Overview of substance abuse/addiction prevention principles including risk and protective factors. NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com
Mental health is about enhancing competencies of individuals and communities and enabling them to achieve their self-determined goals. Mental health should be a concern for all of us, rather than only for those who suffer from a mental disorder. Mental health problems affect society as a whole, and not just a small, isolated segment. They are therefore a major challenge to global development. This presentation focuses on the importance of mental health, the common substance abuse and their influence on mental health.
Kevin W. O'Neil, MD, FACP, CMD and Chief Medical Officer of Internal Medicine and Geriatrics reviews how to navigate the intricacies of substance abuse in older adults.
Overview of substance abuse/addiction prevention principles including risk and protective factors. NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com
Mental health is about enhancing competencies of individuals and communities and enabling them to achieve their self-determined goals. Mental health should be a concern for all of us, rather than only for those who suffer from a mental disorder. Mental health problems affect society as a whole, and not just a small, isolated segment. They are therefore a major challenge to global development. This presentation focuses on the importance of mental health, the common substance abuse and their influence on mental health.
Women's right to mental health scwsd 14 9-06VIBHUTI PATEL
Mental health issues of women are gaining ground in the social work discourse. Universalist ETIC approach is found limiting in dealing with mental health problems. EMIC approach that emphasises cross-cultural psychiatry and evaluates mental health condition of women from within a culture is found more useful. Worsening socio-economic and political situation has enhanced the rates of common mental disorders and minor psychiatric morbidity. Trauma caused by violence against women should be tackled with the help of psychotherapy and psychoanalysis. The paper also discusses mental issues of adolescent girls, substance abusers, HIV-AIDS patients and women in reproductive age group. Media can play progressive role by providing empowering role models for women. Mental health of women in shelter homes, mental hospitals and police custody\ prison needs enlightened intervention by the state, non-government organisations and civil society. Self help groups provide democratic space for rebuilding broken lives. To make women’s material reality more secure, liberating and healthy, breakthrough counselling is need of an hour. Sensitization and training of general practitioners and other health personnel with this objective is a must. Ethics of valuing and respecting others must be observed by the counsellor. The counsellor should know that healing is a part of empowerment.
This course provides training and CEUs for addicitons counselors and LPCs working in Addictions, Mental Health and Co-Occurring Disorders will help counselors, social workers, marriage and family therapists, alcohol and drug counselors and addictions professionals get continuing education and certification training to aid them in providing services guided by best practices. AllCEUs is approved by the california Association of Alcohol and Drug Abuse Counselors (CAADAC), NAADAC, the Association for Addictions Professionals, the Alcohol and Drug Abuse Counseling Board of Georgia (ADACB-GA), the National Board for Certified Counselors (NBCC) and most states.
Alcoholism has became the one of the leading cause for kidney and liver diseases. In India alcoholism is the root cause of poverty, unemployment, domestic conflicts, occupational disputes and deaths all together. Several Indian studies have shown the increased risk of suicide due to alcohol dependency. Thus it has became the global cause for depletion of human species all way round. Awareness, prevention, promotion, restoration and maintenance of health should be held up as essential base to work on for diverting the substance use/abuse and misuse and directing towards the sober community norms step by step to reduce intoxication, dependency, tolerance, conditioned learning and addiction as a whole.
Biopsychosocial Model in Psychiatry- Revisited.pptxDevashish Konar
Over time our understanding of Psychiatric illnesses has undergone sea changes but yet the age old Bio-psycho-social model of etiology remains relevant. This presentation is an effort to explore the model in context of the newer developments.
This presentation is about geriatric Psychiatry awareness. it contains basic information about what is geriatric psychiatry, which are the main psychiatry disorder found in elderly and how to manage them?. it contains some detailed information about late life depression, delirium and dementia in geriatric population.
Geraldine Strathdee and Jen Hyatt: Technology innovation for supporting patie...Nuffield Trust
Geraldine Strathdee, Oxleas NHS Foundation Trust,and Jen Hyatt, Big White Wall, present in a breakout session on using technology to support people with mental health issues at home.
Women's right to mental health scwsd 14 9-06VIBHUTI PATEL
Mental health issues of women are gaining ground in the social work discourse. Universalist ETIC approach is found limiting in dealing with mental health problems. EMIC approach that emphasises cross-cultural psychiatry and evaluates mental health condition of women from within a culture is found more useful. Worsening socio-economic and political situation has enhanced the rates of common mental disorders and minor psychiatric morbidity. Trauma caused by violence against women should be tackled with the help of psychotherapy and psychoanalysis. The paper also discusses mental issues of adolescent girls, substance abusers, HIV-AIDS patients and women in reproductive age group. Media can play progressive role by providing empowering role models for women. Mental health of women in shelter homes, mental hospitals and police custody\ prison needs enlightened intervention by the state, non-government organisations and civil society. Self help groups provide democratic space for rebuilding broken lives. To make women’s material reality more secure, liberating and healthy, breakthrough counselling is need of an hour. Sensitization and training of general practitioners and other health personnel with this objective is a must. Ethics of valuing and respecting others must be observed by the counsellor. The counsellor should know that healing is a part of empowerment.
This course provides training and CEUs for addicitons counselors and LPCs working in Addictions, Mental Health and Co-Occurring Disorders will help counselors, social workers, marriage and family therapists, alcohol and drug counselors and addictions professionals get continuing education and certification training to aid them in providing services guided by best practices. AllCEUs is approved by the california Association of Alcohol and Drug Abuse Counselors (CAADAC), NAADAC, the Association for Addictions Professionals, the Alcohol and Drug Abuse Counseling Board of Georgia (ADACB-GA), the National Board for Certified Counselors (NBCC) and most states.
Alcoholism has became the one of the leading cause for kidney and liver diseases. In India alcoholism is the root cause of poverty, unemployment, domestic conflicts, occupational disputes and deaths all together. Several Indian studies have shown the increased risk of suicide due to alcohol dependency. Thus it has became the global cause for depletion of human species all way round. Awareness, prevention, promotion, restoration and maintenance of health should be held up as essential base to work on for diverting the substance use/abuse and misuse and directing towards the sober community norms step by step to reduce intoxication, dependency, tolerance, conditioned learning and addiction as a whole.
Biopsychosocial Model in Psychiatry- Revisited.pptxDevashish Konar
Over time our understanding of Psychiatric illnesses has undergone sea changes but yet the age old Bio-psycho-social model of etiology remains relevant. This presentation is an effort to explore the model in context of the newer developments.
This presentation is about geriatric Psychiatry awareness. it contains basic information about what is geriatric psychiatry, which are the main psychiatry disorder found in elderly and how to manage them?. it contains some detailed information about late life depression, delirium and dementia in geriatric population.
Geraldine Strathdee and Jen Hyatt: Technology innovation for supporting patie...Nuffield Trust
Geraldine Strathdee, Oxleas NHS Foundation Trust,and Jen Hyatt, Big White Wall, present in a breakout session on using technology to support people with mental health issues at home.
Slide presentations from "Improving care for people with psychosis in North West London", an event hosted by Imperial College Health Partners on 10th February, 2015.
Day 1: Challenges and opportunities for better detection, diagnosis and clini...KTN
The focus of this session is to explore how the UK health system is currently responding to the increasing number of patients with multiple long-term conditions and the impacts of healthcare inequalities on patient outcomes. We will also explore opportunities for businesses to bring about much needed innovations in the prevention, early diagnosis and management of multi-morbidity.
Improving mental health through patient and professional partnershipAmarShahELFT
Slides from the session at the International Forum on Quality and Safety in Healthcare 2016 (Gothenburg) - Improving mental health through patient and professional partnerships
Trying to sketch an agenda for how health psychology and public health can work together. Slides for the discussion workshop at the Division of Health Psychology Conference September 2014.
Presentation of current evidence for promotion of mental wellbeing and prevention of mental disorders. The presentation argues for moving from research to action, using the mental health in all policies approach.
This invited presentation for the Institute of Health Visiting Leadership Conference gives a DPH view on the future of Child Public Health and the need for a systems approach
Update on regional performance of the South West and South East Early Intervention in Psychosis (EIP) programme including the support offered to NHS England to achieve the nationally set standards.
South EIP Peer Support Worker Forum 21st October 2020Sarah Amani
The South of England Early Intervention in Psychosis (EIP) Programme welcomed EIP Peer Workers and Carer Peer Support Workers to the third forum with guest speakers Nev Jones who shared some insights on how peer support is developing in the USA and some of the challenges, which appear to be similar to those we face in the UK.
Working Together to Support Recovery by Using Digital Technology in Healthcare Sarah Amani
There is a lot of talk of how technology can ease our day to day struggles and improve our quality of life, but very little in terms of real life and evidence based examples. Here we illustrate a few ideas and projects that illustrated impact
Early Intervention in Psychosis Programme Briefing March 2017Sarah Amani
In 2015, NHS England (South) commissioned Oxford Academic Health Science Network (AHSN) to establish the South Region EIP Programme. At the time, Oxford AHSN had an EIP Network spanning the Thames Valley and early findings suggested that the network was well placed to offer support to the wider South region. The programme established a board to oversee governance and a Clinical & Technical Group to deliver the EIP standards. The following slides capture some of the work that the programme has delivered and its impact.
EIP Workforce Calculator Dr Julia RentonSarah Amani
EIP stands for early intervention in psychosis and EIP teams are specialist community mental health teams that treat individuals with a first episode of psychosis. As well as the new access and waiting time standards, from April 16 these services are being supported by an additional £30m to improve provision. To receive NICE concordant care, patients need access to two types of psychological therapies, CBT for psychosis and Family Intervention. The primary concern for HEE therefore is to commission training to increase capacity in teams to deliver these therapies. See our Mandate commitment to this in sections 4.5, 4.9 and 4.10.
The Department of Health are transferring £5m to HEE so we can support providers to be able to deliver the increase in EIP delivery and services. The money will be received in late September and there is every expectation from DH this will spent within this financial year.
For more information please see: https://www.hee.nhs.uk/our-work/hospitals-primary-community-care/mental-health-learning-disability/mental-health/early-intervention-psychosis
South Region CCG Mental Health Masterclass - EIP Preparedness ProgrammeSarah Amani
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.
Social Media - A Connected Way of Life: Lessons from using social media to ad...Sarah Amani
The role of social media in enhancing connection and communities has been under question for some time. Using several case studies, a case is made to improve the digital literacy and social media capabilities of healthcare staff in order to amplify their effect and impact.
Lessons from Early Intervention in Psychosis Sarah Amani
The power of networks lies in the rich connections which foster cross pollination of ideas and collaboration whilst dismantling silos, speeding up innovation and adoption. The Early Intervention in Mental Health Network is an opportunity for young people, families, clinicians, researchers and managers to use their collective experience and expertise to improve mental health services for adolescents and young adults.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
3. Welcome & Opening Remarks
Gary Ford CBE
Chief Executive, Oxford AHSN
31st March 2015
4. AHSN core purpose – health and wealth
• Licensed by NHS England for 5 years to deliver four objectives:
• 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.
• 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.
• Build a culture of partnership and collaboration: promote inclusivity, partnership and
collaboration to consider and address local, regional and national priorities.
• Create wealth through co-development, testing, evaluation and early adoption and spread of
new products and services.
#ei2020
5. What and where are we?
Oxford AHSN – 1 of 15 in England
3.3M population
Annual NHS spend circa £5bn
NHS employees 65,000
12 Clinical Commissioning Groups
4 Local Enterprise Partnerships
12 Councils
Major international companies
300 Life Sciences businesses
Complex landscape with many providers and agencies
#ei2020
9. the most positive development in mental health
services since the beginning of community care.
...no where else have we seen the constant high
standards, recovery ethos, co-production and
multi-disciplinary team working.
“
“
”
”
Schizophrenia Commission, 2012
#ei2020
12. Oxford AHSN Early Intervention in
mental health theme will:
• 1. Reduce variation in care in early psychosis
across the AHSN and improve outcomes
• 2. Increase research activity in early psychosis
– in causes, treatments and service delivery
• 3. Extend early intervention across other
conditions
#ei2020
13. • What proportion of young people with a first
episode of psychosis in the Thames Valley
currently have access to an Early Intervention in
Psychosis service?
#ei2020
14. Proportion of young people with
psychosis in Thames Valley under EIP
service = 20%
#ei2020
15. #ei2020
Given that 6% of all young people are not in
employment education or training, to the nearest 10%,
what % of young people with psychosis do you think are
NEET in Thames Valley?
16. Not in Education, Employment Training with psychosis: 70%
19%
24%
12%
26%
22%
15% 18%
27%
18%
14%
23%
27% 28%
9%
6%
7%
9%
10%
8%
7%
7%
9%
10%
14%
15%
9%
72% 70%
81%
64%
68%
77% 76%
66%
72%
76%
63%
58%
64%
100%
NHS
Wokingham
CCG
138
NHS
Windsor,
Ascot and
Maidenhead
CCG
148
NHS South
Reading
CCG
194
NHS Slough
CCG
272
NHS
Oxfordshire
CCG
747
NHS North
& West
Reading
CCG
150
NHS
Newbury
and District
CCG
123
NHS Milton
Keynes CCG
357
NHS
Chiltern
CCG
387
NHS
Bracknell
and Ascot
CCG
213
NHS
Bedfordshire
CCG
448
NHS
Aylesbury
Vale CCG
210
Oxford
AHSN
3,532
Employed
Students in full-/part-time education
NEET (Not in Education, Employment or Training)
Source: Oxford AHSN user data contained in HES and MHMDS datasets licensed from HSCIC, 2014 #ei2020
17. Early Intervention achieves better outcomes for those with
psychosis across Thames Valley
23% 18%
11%
37%
41% 48%
33%
36%
15% 7%
10%
15%
18%
19%
7%
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%
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 #ei2020
18. #ei2020
What is the average length of stay in hospital for a young person with
psychosis?
19. Average length stay = 8 weeks.
40
-31%
Average
inpatient stay
/person/year
(days), 16-
35yrs
57
947
38%
+24%
Proportion
of users
that get
admitted,
2 years,
16-35yrs
31%
Seen only by other teams
Seen by Early Intervention teams in 2010-13
1.5 -10%
Average
admissions
per person per
year, 16-35yrs
1.6
Savings per 16-35 year old person per year
@£300/bed day is £5,100
Source: Oxford AHSN user data contained
in HES and MHMDS datasets licensed from
HSCIC, 2014
16-35 yrs
only
#ei2020
20. How are we making a difference?
#ei2020
Lets hear it from our quality champions..
Make your pledge today
21. Early Intervention in Mental Health:
Extending Early Intervention
Mark Allsopp
Joint Network Lead
22. Early Intervention in Psychosis
intervention n.
Interference so as to modify a process or situation.
• early identification - teenage and early adult
• facilitating access and engagement with services
• reducing stigma
• promptly starting effective treatment
• improving compliance by education and minimising side -effects
• providing intensive psychological and social supports to promote recovery
and prevent relapse
23. Prevention
Primary prevention
Methods to avoid occurrence of disease either through eliminating disease agents or increasing resistance
to disease. Examples include immunization against disease, maintaining a healthy diet and exercise
regimen, and avoiding smoking.
Secondary prevention
Methods to detect and address an existing disease prior to the appearance of symptoms.[1] Examples
include treatment of hypertension (cardiovascular disease), cancer screenings, identification of prodromal
or at risk mental states in Psychosis
Tertiary prevention
Methods to reduce negative impact of symptomatic disease, such as disability or death, through
rehabilitation and treatment. Examples include surgical procedures that halt the spread or progression of
disease, medication compliance and relapse prevention in EIP
24. Early
adjective, earlier, earliest.
1. occurring in the first part of a period of time, a course of action, a series
of events, etc.:
assertive intervention early in the course of a first episode psychosis
2. occurring before the usual or appointed time:
early identification and engagement in EIP service
3. appearing or maturing before most others of its type:
the early presentation of psychosis in a 14 year old.
25. Our Network Priorities
Our focus is :
• on young people in adolescence and early adult life.
• on identifying Mental Health conditions arising in that period of the lifespan early
• on facilitating access to and engagement with services in innovative ways
We will prioritise:
• those conditions with with high continuity and with significant risk of becoming severe and enduring if not addressed early.
• those conditions where there is evidence of, or potential for, effective early interventions
• those conditions where there is evidence of low uptake of interventions.
• and/or evidence of impact of symptoms on social and occupational functioning in adult life and /or cost of health care
26. Find innovative ways to help young people with mental health conditions improve
access and engagement with services, obtain the right intervention at the right time,
and continuity of care
When relevant transfer elements of the early intervention in psychosis model to
other mental health conditions
Explore ways in which existing early intervention in psychosis services might be
extended in scope and time
Through Our Extending Early Intervention Steering Group we want to:
27. Collate the evidence and experiences available nationally and internationally for
services which provide services for 16-25 year olds, and services which provide
alternatives to inpatient admission for young people
Scope the mental health conditions which arise in adolescence and young
adulthood to explore research evidence for the effectiveness of early
intervention strategies
Explore evidence and experience of best practice in transition and joint working
between CAMHs and AMHs to see what can be applied in EIP services locally
Through Our Extending Early Intervention Steering Group we have started to:
28.
29. Alternatives to inpatient mental health care for children and
young people
Sasha Shepperd1, Helen Doll1, Simon Gowers2, Anthony James3, Mina Fazel3, Ray
Fitzpatrick1, and Jon Pollock4
Authors’ conclusions—
The quality of the evidence base currently provides very little guidance
for the development of services.
If randomised controlled trials are not feasible then consideration should
be given to alternative study designs, such as prospective systems of
audit conducted across several centres, as this has the potential to
improve the current level of evidence.
These studies should include baseline measurement at admission along
with demographic data,and outcomes measured using a few
standardised robust instruments.
30. Network of Networks 1
Strategic Clinical Network for Adult Mental Health :
Crisis Care Concordat
Physical Health Monitoring
Strategic Clinical Network for Children and Maternity:
Improved access in community CAMHS
Transition between CAMHS and AMH
Early identification of puerperal psychosis
31. Network of Networks 2
Oxford Academic Health Science Best Practice Networks
Anxiety and Depression ( IAPT):
Social Anxiety
Severe Mood Disorders
IAPT for Teenagers
Dementia:
Identification early in presentation
Services for Younger Adults
32. An Example : Obsessive Compulsive Disorder
Recent Public Health Data of community based samples has improved but confirmed results of
clinical samples from 1980 onwards
Obsessive-Compulsive Disorder: Prevalence, Comorbidity, Impact, and Help-Seeking in the British
National Psychiatric Morbidity Survey of 2000.
Torres et al Am. J. Psychiatry 2006
“Our data suggest that obsessive-compulsive disorder does not fit conveniently into the fashionable
relabelling of neurosis as “common mental disorder” and psychosis as “severe mental illness.”
Obsessive-compulsive disorder is a neurosis that is both rare and severe and should be prioritised
accordingly.”
The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey
Replication ( US 2001 -2003)
Ruscio et al Molecular Psychiatry 2010
33. An Example : Obsessive Compulsive Disorder
Onset in Young People:
Peak incidence between 16 and 19 years with > 90% before 30
12 month prevalence 1.2% , lifetime prevalence 2.3%
Females 1.4%, Males 0.9% . Those with very early onset mainly males
High Continuity
Most run a relapsing and remitting course
Those who develop OCD spend a mean of 8.9 years with the disorder
Prevalence reduces in later adult life
34. An Example : Obsessive Compulsive Disorder
Evidence of Effective Interventions
Trials of SSRI anti-depressants effective in adolescent and adult populations
CBT trials demonstrated effective in adolescent and adult populations
NICE guidance 2005
Each PCT, mental healthcare trust and children's trust that provides mental health services should have
access to a specialist obsessive-compulsive disorder (OCD)/body dysmorphic disorder (BDD)
multidisciplinary team offering age-appropriate care. This team would perform the following functions:
increase the skills of mental health professionals in the assessment and evidence-based treatment of
people with OCD or BDD, provide high-quality advice, understand family and developmental needs, and,
when appropriate, conduct expert assessment and specialist cognitive-behavioural and pharmacological
treatment.
35. An Example : Obsessive Compulsive Disorder
Low uptake of interventions
Significant delay in seeking help : embarrassment , stigma.
57% British sample not in contact with services
US sample higher, but only if co-morbidity. If no Co-morbidity only 14% receiving help
Evidence of impact on social function
Severe or moderate impairment a) Home management 71%, b) work 51% c) relationships 57% d) social
life 53% e) any domain 79%
OR for work or social impairment vs Neuroses 2.8 . 50% living alone. 50% unemployed. 86% earning
under £300 per week
25% reported life-time suicidal acts OR vs Neuroses 2.0
36. An Example : Obsessive Compulsive Disorder
So OCD meets our Priorities and much evidence
already exists.
But is not the only example - where do we put
our energies?
Take for example eating disorders ………
37. The case for early intervention in anorexia nervosa: theoretical
exploration of maintaining factors
Janet Treasure and Gerald Russell
Summary:
Here we revisit and reinterpret the original study in which the so-called ‘Maudsley (London)
model’ of family therapy was compared with individual therapy for anorexia nervosa.
Family therapy was more effective in adolescents with a short duration of illness. However,
this is only part of the story. A later study describing the 5-year outcome contains important
information. Those adolescents randomised to
family therapy achieved a better outcome 5 years later.
Moreover, the group with an onset in adolescence but who had been ill for over 3 years had a
poor response to both family and individual therapy, suggesting that unless effective
treatment is given within the first 3 years of illness onset, the
outcome is poor. We examine other evidence supporting this conclusion and consider the
developmental and neurobiological factors that can account for this.
The British Journal of Psychiatry (2011)
199, 5–7. doi: 10.1192/bjp.bp.110.087585
38. Guidance to support the introduction of access and waiting time
standards for mental health services in 2015/16 :
Eating disorders
The Autumn Statement 2014 outlined the provision of additional funding of £30million recurrently for 5 years to be invested in
a central NHS England programme to improve access for children and young people to specialist evidence-based community
CAMHS eating disorder services.
Part of this programme funding will be used to develop an access and waiting time standard.
The aims of the programme are to:
Deliver swift access to evidence based community treatment for children and young people with eating disorders;
Reduce demand for specialist inpatient beds;
Reduce relapse;
Reduce transfers to adult services and mitigate the problems of transition for young people with eating disorders when they
turn 18 through the development of care pathways for children and young people up to the age of 25;
Ensure a consistent evidence-based outcomes- focussed model of care;
Through ring-fenced investment in specialist eating disorder services, build capacity within general CAMHS so that a greater
number of children and young people with other mental health problems, such as self harm, can access
39. More than 1.6 million people in the UK are estimated to be directly affected by eating disorders (ED). Anorexia nervosa has the highest
mortality amongst psychiatric disorders. The CAMHS Tier 4 review (May 2014) noted that ED was the largest category of sub-specialist beds.
NICE (2004) recommends:
That most people with anorexia nervosa should be managed on an outpatient basis with psychological treatment provided by a service that is
competent in giving that treatment and assessing the physical risk of people with eating disorders.
Family interventions that directly address the eating disorder should be offered to children and adolescents with anorexia nervosa.
Research shows that areas with specialist community CAMHS Eating Disorder services:
Better identify ED in primary care;
Have lower rates of admissions with non-specialist CAMHS admitting more than 2.5 times as many people;
Demonstrate significantly lower relapse rates (5-10%) for children and young people who have responded well to outpatient family therapy
than those following inpatient care and there is some evidence that long-term admissions may have a negative impact on outcomes.
Are more Cost-effective over 2year follow up
40. Eating Disorders
NHS England has commissioned the National Collaborating Centre for Mental Health to set up an Eating
Disorders Expert Reference Group (ERG), which will meet in early 2015.
This is separate from the review NICE is undertaking to the ED guidelines published in 2004, although
information and learning will be shared.
The ERG will develop:
A service model for providers and commissioners;
The access and waiting time standard that will be put in place from 2016; and
A specification for any necessary amendments to the CAMHS Minimum Dataset.
There will be support to train existing and new staff in the appropriate model of care and to assure
progress, including supporting clinical network development.
41. Help clinicians and managers in the Thames Valley area map existing services,
improve early identification and access, and plan for the integration of the new
service model in their locality
Use and share research evidence , local experience and innovation to help
evolve high quality cost effective eating disorders services for young people up
to the age of 25 years
Develop means to benchmark provision and reduce unwarranted variation in
outcome in the Thames Valley area
Through an Early Intervention in Eating Disorders Best Practice Group we could
begin to:
42. Use technology, innovation and young people’ s involvement to improve access and
engagement with services. Explore whether 16-25 services, or alternatives to
admission services are beneficial.
Use existing evidence to transfer when applicable elements of the early
intervention model to other conditions such as OCD, Eating Disorders, Severe
mood disorders and emerging Personality Disorder
Explore ways in which CAMHs and existing early intervention services can work
together to ensure all young people obtain the right intervention at the right
time, are not excluded from evidence based interventions where they exist and
have good continuity of care
In Summary :
Through Our Extending Early Intervention Steering Group we want to:
44. • Reduce variation in care for young people with psychosis across the
AHSN
• Improve outcomes for young people with psychosis
Objective 1: Reduce Variation in Care
#ei2020
45. 23% 18%
11%
37%
41% 48%
33%
36%
15% 7%
10%
15%
18%
19%
7%
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
Comparison of Education, Employment Status
#ei2020
46. • Reduce variation in care for young people with psychosis across the
AHSN
• Improve outcomes for young people with psychosis
Objective 2: Common Assessment
#ei2020
47. • Increase research activity and recruitment to research amongst young
people experiencing a first episode of psychosis
Objective 3: Increase Research Participants
Measure Target Timing
Research champions identified in EIP teams 4 QC & 2 RAs
recruited
August
2014
Number of research studies and current activity identified Number of
participants
per study
October
2014
Database of research ready participants in EIP Develop secure
database
July 2015
Accruals to Portfolio research studies 50% increase
ref: 2013
April 2016
Number of research studies active in EIP Increase ref:
2013
April 2015#ei2020
50. • Improved transition between child and adult mental health teams
• Extend early intervention for young people with other conditions
Objective 4: Extend EI Model to Other Conditions
#ei2020
51. Mind the Gap
AMHS
18-65 years
Primary Care and General Practitioners
EIP*
14-35 years
*For psychosis only
CAMHS
0-18 years
#ei2020
52. Resilience Development
in Schools
Whole school approach to
mental health and wellbeing
– ethos, curriculum, positive
behaviour, anti-bullying,
pastoral care…
Resilience Development in
Communities
Strong network of youth
services, voluntary and
community organisations,
confident and skilled to support
and intervene early
Responding to Distress
Frontline staff in many
agencies should be helped to
develop confidence and
supported to intervene and
help children and young
people in situations of
distress, including self harm
and risk of suicide
Guiding Through the
Service Maze
Children, families & young
people have range of
support options for early
intervention and need to be
helped to find their way to
appropriate help quickly
Peer help & Social Media
Those who share their
problems enjoy better mental
health - build opportunities for
young people to provide peer
support, and to use social
media for wellbeing
One Good Adult
Importance of dependable
adult to support and
protect mental health of
child and young person –
e.g. strengthen parenting,
mentoring, guidance,
befriending initiatives
Systematic Review: Improving Continuity of Care
#ei2020
54. School-based mental health services
Looking to the future
Mina Fazel
NIHR Post-Doctoral Research Fellow,
Department of Psychiatry, University of Oxford
Consultant in Child and Adolescent Psychiatry
Children’s Psychological Medicine, Oxford University Hospitals
55. • Mental health of school-aged children
• School-based mental health
– What is it?
– TaMHS project
• Oxfordshire PCAMHS InReach service
– What has happened so far
– Advantages and challenges of working in school
– Future
Overview
56. Chief Medical Officer
“There is a great need for earlier treatment
for children and young people with mental
health problems. Half of adult mental
illness starts before the age of 15 and 75%
by the age of 18. Unless young people get
help, they risk a life of problems including
unemployment, substance misuse, crime
and antisocial behaviour. Under-investment
in mental health services, particularly for
young people, simply does not make sense
economically”
CMO Annual Report, 9th September 2014
57. Children‘s mental health needs in the UK
40%
Currently treated within NHS context
Effective psychological interventions
exist
Children with significant clinical needs not
effectively reached by mental health
providers
High persistence of disturbance into adult
life
School front-line workers (TAs, SENCOs)
already spending considerable time
supporting these children
Vulnerable populations overrepresented
in this group
20%
4%
10%
60%
90%
Anxiety or
Depression
Conduct
Disorder
ADHD
Other (1%)
Children
untreated
*
Children with
psychiatric disorders
*
58. In a given classroom of
25 students….
1 in 5 will
experience
a mental
health
problem of
mild
impairment
1 in 10 will
experience
a mental
health
problem of
severe
impairment
Less than half of those who need it will get services
59. IS IT IMPORTANT TO IMPROVE
EARLY DETECTION OF MENTAL
HEALTH PROBLEMS IN YOUNG
PEOPLE WITHOUT PARALLEL
INCREASES IN SERVICE PROVISION?
Question 1
60. WHAT IS A MAIN REASON WHY
YOUNG PEOPLE WHO MIGHT NEED
SERVICES DO NOT ACCESS THEM?
Question 2
61. UK School-based mental health
• Targeted Mental Health in Schools (TaMHS)
(2008-2011)
– £60 million programme
– innovative, locally determined models
– early intervention for 5-13 year olds at risk
– Included 3000 schools in 151 Local education
authorities (LAs) who determined budget allocations
• Longitudinal study and RCT
– 137 primary and 37 secondary schools
62. TaMHS evaluation
• Findings:
– More positive links with mental health services associated with
greater reductions in behavioural problems in secondary school
– Parents reported schools as key point of first contact for mental
health advice for child
• Implications:
– Prioritise improved relationships and referral routes between
secondary schools and mental health services
– Ensure schools retain a role in referral
• Future policy implementation:
– Balance: prescriptiveness and flexibility
– Emphasis on integration of services in schools
63. American experience
• Established school mental health for >30 years
• Over 2000 school-based mental health services
• Growing evidence-base
• Visits for mental health needs second highest after
accidental injury
• 75% of children receiving mental health care receive it in
the school system
• Fewer DNA and drop-outs
• 12% American child psychiatrists spending time in schools
64. What are school-based mental health interventions?
Who gives the treatment?
To
whom?
Whole
school
Classroom
Pupils at
risk
Diagnosed
pupils
What
treat-
ment?
Cognitive
behavioural
therapy
Behavioural
intervention
Art therapy
Counselling
Medication
Family therapy
Important prevailing issues
Internal External
Consent? Confidentiality Evidence based
1
2 3
4
Peers Pastoral
support
staff
Teachers School
counsellors
School
nurse
School
psychologist
Charities Mental
health service
Whose responsibility?
£
65. Types of School Interventions
Treatment/Indicated:
Cognitive Behavioral Intervention for Trauma in Schools,
Coping Cat, Trauma Focused CBT, Interpersonal Therapy
for Adolescents (IPT-A)
Prevention/Selected:
Coping Power, FRIENDS for Youth/Teens, The Incredible
Years, Second Step, SEFEL and DECA Strategies and Tools,
Strengthening Families Coping Resources Workshops
Promotion/Universal:
Good Behavior Game, PATHS to PAX, Positive Behavior
Interventions and Support, Social and Emotional
Foundations of Early Learning (SEFEL), Olweus
Bullying Prevention, Toward No Tobacco Use
67. Oxfordshire Services
Mental health services
• Discontent about availability and access of mental health services
• Overwhelmed services
– 30% increase in referrals
Education
– 34 state funded secondary schools
• 7,000 children per school year
– Over 20 independent schools
– Mental health provision in schools
• School-dependent
– School counsellors
– Pastoral care system
– No strong links with local mental health services
68. School: Location quotations
I don’t know maybe it would be more complicated or
something …. Maybe just to find it and maybe she doesn’t
know who you are, where you come from, … I don’t know
it’s just different. I think in the school is better
Good to have it in school, if come to hospital it is scary, I
don’t know if I would go if it was in a hospital …no one likes
hospital
69. Oxfordshire Opportunity
• Oxford Health NHS Foundation Trust
– Uniquely placed to develop school-based mental health services
• Newly commissioned school health nurse service for secondary
schools
• Mental health: PCAMHS and CAMHS
• Oxford University
• To develop and evaluate a new school-based mental health
service in Oxfordshire secondary schools by placing existing
Primary Child and Adolescent Mental Health Service
(PCAMHS) workers into each school for a fixed weekly
session
70. The Oxford PCAMHS InReach Service
Consult
with teachers
and other
key school
professionals
Specific
school
Group
interventions
Give
assemblies, talk
to parents
1:1
treatment
PCAMHS
worker
Half a day
each week
71. What might be the effect of this for
Oxford services?
• See young people earlier in services
• See more young people as many have difficulty accessing
services
• Engagement might improve with fewer non-attendances
• Help schools manage difficult and concerning problems on
– Individual cases
– Classroom problems
– Whole school difficulties
• Provide additional support to school staff
72. Roll-out plan
• Roll out slowly (ish)
– 3 schools May 2014
– 10 more January 2015
– more with each subsequent term
• Monitor PCAMHS worker activities
• So far:
– New service welcomed by school staff
– Schools holding considerable risk within their systems of care
– Learning how best to integrate
• Which students
• What happens to the students
• Parental involvement
73. DO YOU THINK CHILDREN BETWEEN
THE AGES OF 12 & 15 SHOULD
HAVE PARENTAL CONSENT TO
ACCESS MENTAL HEALTH SERVICES?
74. PCAMHS worker utilisation in schools
– Training
• Whole school assembly
• Teachers and pastoral care system
– Individual cases
• Can see for brief interventions
• Convenient
• Follow-up easier
– Interface with pastoral care system
• Offer supervision
• Non-threatening involvement
75. Challenges 1
• Ethical
– Consent
– Notes & confidentiality
• Screening
– Should we do this
– When and how
– Teacher nomination system?
• Pastoral care systems within schools
– How best to work in collaboration
– Threatened
• Space
• Private schools
76. Challenges 2- Future
• NHS service
– Subject to pressures of service delivery context
• Other models of care in the region
– Swindon
– Milton Keynes
– Local care options
• PCAMHS worker 1 session
• PCAMHS 2 sessions
• PCAMHS + training school nurse
• PCAMHS + training school staff
• PCAMHS + CAMHS/Child psychiatrist
77. IS IT ETHICAL TO DELIVER AND
CHANGE SERVICES WITHOUT
PROPERLY EVALUATING THEM?
Question 4
79. WHO IS BEST PLACED TO CONDUCT
SERVICE EVALUATION?
Question 6
80. How to move forward
• Education and Health Integration challenges
• Services in schools democratises access to
services
– Opportunity for early intervention
– Access the most vulnerable
• Evaluation challenges for health services
– Electronic patient records
81. Personality Disorder: Evidence and
Innovation
Dr Rex Haigh
https://prezi.com/kmh3m1fb6_bg/personality-disorder-evidence-and-innovation/?utm_campaign=share&utm_medium=copy
82. Physical Health & Wellbeing Clinic
Early Intervention in Psychosis Service
Elwira Lubos
Nurse Researcher
83. Outline
1. Why? Ten minute pitch on why this is
important
2. How? What works well within and beyond
the clinic
3. So What? Actions for the future
#ei2020
84. ‘From how I am to how I act’
FUNCTIONINGHEALTHY WEIGHT
ACTIVE & FIT LIFESTYLE ENERGY
MENTAL & EMOTIONAL
BALANCED & NUTRITIOUS DIET
ABILITY TO EXERCISE
85. Why is this important?
1. Life expectancy gap of 15-20 years.
2. Only 35% of this population had adequate physical
health monitoring in the past 12 months (NAS, 2014)
3. Higher mortality related to cardio vascular events
(Crump et al, 2013; Laursen et al, 2012; Wysokinski et al, 2014).
4. Change in NICE guidelines for Schizophrenia (2014)
#ei2020
86. 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.
#ei2020
87. So What?
• Drop-in service for EI clients within Oxfordshire.
• Physical health checks, include weight, BMI, blood pressure, waist
circumference, comprehensive bloods, life style screening, health
advice and signposting.
• Full cardiometabolic monitoring check.
• Side effect monitoring.
• Physical health history and family history of cardiovascular risks/
diseases and diabetes.
• From July till October 2014 - 20 service users attended the drop in.
#ei2020
88. Cardiometabolic Monitoring Results:
0 2 4 6 8 10 12 14
Life style risk factors
Current smoker
Blood pressure over 140/90
BMI over 25 kg/ m2
Cholesterol/ HDL ratio
Blood Glucose over 5 mmol/L
#ei2020
89. top motivators for sustaining behaviour change
Information
HEALTH BEHAVIOUR CHANGE MOTIVATORS
Aspiration Social Influence Incentives
.
.
.
.
Source: Health Barometer, 2014
&
90. Positive ways forward
• Self monitoring, e.g. weight and blood pressure.
• At the point of access provide condition and medication
specific information. Development of apps may be a
way forward.
• Incorporate physical health checks as part of routine
outcome measures.
• More designated staff time to facilitate staff training to
develop roles within the team (champions), and to offer
outreach service.
• Investment in portable ECG machine to assist people
unable to leave home.
#ei2020
92. Raising Awareness of Early
Signs of Mental Health problems in
young people and supporting rapid
access and signposting to services
Gwen Bonner, Head of Adult Mental Health Services, Reading
Berkshire Healthcare NHS Foundation Trust
93. • Similar to other services nationally Early Intervention Services in
BHFT have been eroded to accommodate changes to care
pathways models of working
• Reduction in referrals into services
• Difficulties in the transition from young people to adult services
• Young people coming into services much later than they should be
• Current pathway excludes a number of young people that could
benefit from treatment interventions
Background .
94. • Five month time limited project
• Four nursing staff covering six geographical localities
across Berkshire
• Based within Adult Community Mental Health teams but
linking with CAMHS services
EIP project Berkshire .
95. • To increase awareness and understanding of early signs
of mental health problems in young people in the
communities where they are engaged
• To facilitate early signposting to appropriate services for
young people experiencing MH problems
• To facilitate early assessment and treatment for young
people who have early signs of psychosis
Aims .
96. • Improved understanding by other agencies – schools,
universities and colleges, GP’s, our own internal services
• Early referral into services for appropriate assessment
and treatment
• Increase in referrals into CAMHS for young people
presenting in a prodromal stage of psychosis
• Reduction in unscheduled hospital admissions in acute
and mental health sectors
Desired outcomes .
97. • Four project workers working across six localities
• Map out stakeholders to focus the education intervention
• Develop a training package to take out to a variety of stakeholders
• Review and increase use of technology
• Highlight early warning signs and where to access help and support
• Support early referral into services
• Evaluate impact of training on these stakeholders
• Work with existing teams to support timely access and treatment
The project .
98. • Baseline number of people receiving training package –
broken down by agency / organisation
• Evaluation of training impact – post session survey
• Increase in referrals in for young people for assessment
Key performance indicators .
99. • Evaluate project impact
• Awaiting outcome of substantial funding bid
• Integrate this approach into above
• Work with AHSN around informatics for future –
establish comprehensive national picture
Next steps .