Leap's early look

Emma Forrest on a pioneering early intervention team

One of the mental healthrelated promises made in the NHS plan was that 'all young people who develop a psychosis will receive intensive support during the critical early years'.

It is a bold ambition, and one that should see 50 early intervention teams in place across the country by the end Pof the year.

Each area with a population of one million or over must develop a service comprising three or four teams, with at least one team in place by April.

They support service users for three years - a crucial time in the development of psychotic illness and attempts to change the prognosis of sufferers.

One such group is Leap - Luton Early Action in Psychosis. An early intervention team at Bedfordshire and Luton Community trust, it was instigated through the interest of team associate specialist Dr Mark Agius and psychiatrists working in the area.

In early 2001, they began to identify patients they thought would benefit from such a service. They ran clinics for them as part of their everyday work with the community mental health team, while making plans for an early intervention service.

After talks with commissioners, during which Luton primary care trust was the first to commit funds, recruitment for the formal team began last June. Teams for elsewhere in the region, commissioned by Bedford and Bedfordshire Heartlands PCTs, are currently being recruited.

Dr Agius claims the trust has created the first complete early intervention team in the country and will be the first to provide a complete service in what he calls a flagship service for the trust.

Since the team was piloted in 2001, it has seen over 100 clients, around 80 of whom are still being managed by the team. Numbers have grown, with the majority of clients being young men - the average age for onset of psychosis is 22, although there are clients as young as 16 and some in their early 30s. Clients usually present for the first time with psychotic symptoms such as hallucinations or delusions.

The majority of referrals come through the community mental health team, although hostels, homeless centres and social services have also referred clients to the team. Referrals from GPs are increasing, and Dr Agius plans to introduce more local GPs to the service.

Depending on how well the person is, two team members will visit them or they will be asked to come into the team's headquarters before being referred to the appropriate service.

'It is important to see people.

You cannot diagnose over the phone and we need to encourage people to refer to us, ' says Dr Agius.

Before the launch of Leap, he explains, early onset sufferers were often diagnosed late, were lost, due to their age, into the gap between children/adolescent and adult services, or were misdiagnosed as having a drugrelated psychotic episode, which was not followed up.

Luton's social make-up means such interventions are crucial.

The town has high rates of deprivation, a large number of ethnic minorities and a high rate of immigration into the area, all of which can lead to a high rate of mental illness.

If assessed as being in need of Leap, they are assigned one of nine case managers, including a team leader.

Dr Agius, another doctor and a psychologist make up the remainder of the team, although a social worker is to be recruited.

A consultant oversees Dr Agius's work. No case worker has more than 15 people on their list, in order to give the intensive support needed. This is in contrast to the typical workload of a community psychiatric nurse, who may have as many as 50 patients.

Although based in the trust's headquarters in the centre of Luton, the offices have a separate entrance and there is little, bar a discreet sign, to suggest that they have anything to do with mental health.

A central location was chosen rather than a base at a psychiatric hospital in order to encourage the service's young clients to visit.

Case workers act more as 'friends and mentors than nurses', explains Dr Agius.Meetings between worker and client may take the form of going out for a meal or shopping. A combination of medication and intervention therapies, such as cognitive behavioural therapy, is also used.

'We want to avoid them becoming a chronic patient, ' says Dr Agius, pointing out that twothirds of patients who experience a psychotic episode are likely to do well in future, and that if relapses do occur the service aims to increase the amount of time between episodes.

After three years, users may be discharged, referred to the community mental health team, or to another service, such as an assertive outreach team.

It is hoped that research will begin into early intervention techniques, with Cambridge University, and collaboration may begin with other trusts which are developing their own early intervention services.

Dr Agius also hopes the service can begin to start looking after patients before they become psychotic.

'In future, what I would like to happen is for a young person with a family history of schizophrenia, suffering from severe depression and anxiety, to be referred to us by a GP in order for us to be able to monitor them.

We cannot guarantee outcome, but there are clients who had to give up work or college and are now leading a near-normal life.

That is the best outcome we can hope for.'

For information on contributing to HSJ's fortnightly mental health page, e-mail emma. forrest@emap. com