Early intervention psychosis projects successful, despite staff and budgetary issues

Psychosis was characterised by “losing touch with reality”, often involving hallucinations, delusions, and disordered thinking. File picture

Two pilot early intervention projects for people who are beginning to show symptoms of psychosis have demonstrated success, despite ingrained staffing and budgetary problems within the HSE.

The projects – in Cork city and Sligo – provided a rapid assessment of service users with a majority of clients engaging with services and therapies and almost half securing employment. A third pilot project – in Meath – didn't proceed because of challenges in recruiting staff.

The evaluation of the early intervention in psychosis (EIP) services, commissioned by the HSE, was conducted by public health academics in Trinity College Dublin. The report said that while Government strategies – A Vision for Change (2006) and Sharing the Vision (2020) – pledged comprehensive EIP services, the necessary money was not provided.

“A lack of committed funding and resources have impeded the full implementation of EIP services in Ireland,” it said.

The international incidence of psychotic disorders was 32 per 100,000 people, but the reports noted there is a “general lack of information” in Ireland. Psychosis was characterised by “losing touch with reality”, often involving hallucinations, delusions, and disordered thinking.

The programme found that psychosis can cause “considerable distress and disability” for the person, and their family, with increased risk of premature death of up to 25 years and a 10% lifetime risk of suicide.

It said early intervention can have a positive and significant effect, with intervention in the first two to three years “critical”.

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It said the first pilot project – referred to as a “demonstration” project - under a model of care for the National Clinical Programme for EIP was the RISE Cork South Lee initiative in May 2019. The report said the demonstration sites “inherited existing problems from within the HSE”, in the areas of recruitment and funding.

Some 141 service users were helped by the Cork South Lee initiative, while a further 51 were helped in Sligo between 2019 and 2021. South Lee enrolled “significantly more” service users than projected (49 people per 100,000, compared to a projected figure of 26), while Sligo dealt with numbers similar to that projected (around 15).

“It is encouraging both demonstration sites were able to achieve high levels of enrolment,” the report said, adding that the programme was strongly supported by service providers and users. The report said 57% of South Lee users and 34% of Sligo users had assessments within three days, facilitating early intervention.

Highlighting the importance of key workers, it said the research found that increased contact with key workers was “significantly associated” with increased engagement in therapy. It said: “To promote the sustainability and expansion of EIP services, it is recommended that HSE organisational processes related to funding allocation and staffing be radically changed.”