Psychosis & Schizophrenia: The Updated NICE Quality Standard. Dr Tony Gill Mental Health Practitioner University of Leeds 7 th June 2015

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1 Psychosis & Schizophrenia: The Updated NICE Quality Standard Dr Tony Gill Mental Health Practitioner University of Leeds 7 th June 2015

2 NICE.what is it? The National Institute for Health & Care Excellence (NICE) is the independent organisation responsible for providing national guidance and advice to improve health social care

3 Describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, providing an underpinning, comprehensive set of recommendations. Designed to support the measurement of improvement

4 What are NICE guidelines and quality standards? A comprehensive set of recommendations for a particular disease or condition Evidence (e.g. clinical trials, health economic studies) Evidence-based Clinical Guidelines Quality Standards A prioritised, concise set of statements (usually 6-8) with associated measurable indicators, chosen and adapted from the Clinical Guideline recommendations

5 1. Effective therapies 2.Prescribing 3.Education and support

6 Quality Statement One Referral to early intervention in psychosis services Early Intervention can improve outcomes for people with psychosis Severity of psychosis is reduced and Relapse less likely Likelihood of hospitalisation reduced. Potential healthcare savings estimated at 44m (2010) rising to 65m (2026). Sufficient staff resources to provide early intervention within 2 weeks of referral. Report waiting times.

7 Quality Statement Two Cognitive behavioural therapy All adults with psychosis or schizophrenia should be offered cognitive behavioural therapy for psychosis (CBTp), as a first line treatment. Contain at least 16 sessions. Initial cost , follow up 100 total cost of Report to commissioners the number of Service users who complete 16 sessions. CCGs to use this as a quality measure and reviewed

8 Quality Statement Three Family intervention Should be delivered as a course of at least 10 sessions over a period of 3 months to 1 year. The cost of a course of 10 sessions estimated as The intervention should include the person with psychosis or schizophrenia if practical. Should take account of the whole family's preference for a single-family intervention or multi-family group intervention. Report to commissioners the number courses started by families and the proportion who completed 10 sessions.

9 Quality Statement Four Treatment with clozapine Adults should be offered antipsychotic drugs to complement any psychological therapies. The choice should be made by the service user and their healthcare professional. The service user should be made aware of any side effects they can expect. Adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs are offered clozapine. The drug cost is approximately 510 per annum for treating schizophrenia.

10 Quality Statement Five Supported employment programmes It is estimated that just 5 15% of people with schizophrenia are in employment. People with severe mental illness are 6 to 7 times more likely to be unemployed than the general population. Unemployment can have a negative effect on the mental and physical health of adults with psychosis or schizophrenia. Adults who wish to find or return to work are offered supported employment programmes. Supported employment programmes can increase employment rates in adults with psychosis or schizophrenia.

11 Quality Statement Six Assessing physical health Adults with psychosis or schizophrenia have specific comprehensive physical health assessments. Life expectancy for adults with psychosis or schizophrenia is between 15 and 20 years less than for people in the general population. Often have physical health problems, including cardiovascular and metabolic disorders, such as type 2 diabetes.

12 Service providers (such as GPs, community health services and mental health services) ensure that protocols are in place to carry out comprehensive physical health assessments in adults with psychosis or schizophrenia. Health and social care practitioners ensure that they carry out comprehensive physical health assessments in adults with psychosis or schizophrenia. Adults with psychosis or schizophrenia should have a regular health check (at least once a year) that includes taking weight, waist, pulse and blood pressure measurements and blood tests. Share results

13 Quality Statement Seven Promoting healthy eating, physical activity and smoking cessation Adults with psychosis or schizophrenia are offered combined healthy eating and physical activity programmes, and help to stop smoking. Rates of tobacco smoking are also high in people with psychosis or schizophrenia. These factors contribute to premature mortality.

14 Service providers (mental health services) ensure that systems are in place for combined healthy eating and physical activity programmes, and help to stop smoking. Health and social care practitioners ensure that they are aware of local healthy eating and physical activity programmes and offer these to adults with psychosis or schizophrenia. They should also offer them help to stop smoking if they smoke. Adults with psychosis or schizophrenia are offered help with healthy eating and physical activity to help prevent weight gain, diabetes and other health problems that are common in adults with psychosis or schizophrenia and often related to treatment

15 Quality Statement Eight Carer-focused education and support Carers of adults with psychosis or schizophrenia are offered carer-focused education and support programmes. Providing carer-focused education and support reduces carer burden and psychological distress, and may improve the carer's quality of life.

16 Service providers (such as community health services and mental health services) ensure that systems are in place for carers of adults with psychosis or schizophrenia to be offered a carer-focused education and support programme. Health and social care practitioners ensure that they are aware of the role of carers and offer a carer-focused education and support programme to carers of adults with psychosis or schizophrenia Commissioners should also ensure that community and mental health teams are able to work collaboratively with education and support programmes

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