IRIS Guidelines Update September 2012
Revision of the original 1998
IRIS Guidelines
www.iris-initiative.org.uk
NEW IRIS Guidelines
Stephen McGowan
Then…
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IRIS
NSF
PIG
NIMH(E)
NEIP
NMHDU
WHO
IRIS
Early Intervention in Psychosis
Early Detection
Reduced treatment delays
Sustained, phase-specific intervention
through the Critical Period
Improved outcomes
Achievements
• Coverage: Over 60,000
• Outcomes:
- A better course of illness and fewer symptoms
- Halving of suicide rates
- Substantial reduction in admission rates
- 50-60% recovery rates (2011)
• Cost savings:
‘EIP can save in the order of £5,000 per case in year
one, rising to £14,000 by year three compared to
treatment as usual’. (McCrone et al 2009)
Now…
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Partial Reform
World wide recession
Cuts to public services
S75 divorces
Post NSF:
- CCGs
- Block grant payment system
- Payment by Results
• £21bn!
Fourteen years on from the original IRIS guidelines, EIP
has become established as the preferred model of
service for young people with emerging psychosis and
their families:
• Endorsed by NICE core Schizophrenia Guidelines
(NICE CG 82 2009)
• Highlighted in current mental health policy (DH 2011
No Health without Mental Health; Section 7.13; p66)
• A commitment in the 2012/13 NHS operating
framework (DH Nov 2011)
• Featuring in the emerging PbR toolkit cluster 10
• One of the most researched areas in MH
2012 Research Headlines
• People treated by early intervention in psychosis had
significantly fewer admissions, readmissions and total bed days
and better engagement with services (The Psychiatrist, 2008)
• Specialised EI programmes are cost effective over the long term
and can deliver a higher recovery rate at 33% of the cost of
standard mental health services. (Schizophrenia Bulletin, 2009)
• For people with early psychosis, early intervention services
appear to have clinically important benefits over standard care
improving access to treatment and reducing hospital
admission, relapse rates and symptom severity (BJPsych, 2010)
• Functional recovery at 14-month follow-up significantly
predicted both full functional recovery and remission of
negative symptoms at 7.5 years. Early recovery plays a pivotal
role in preventing the development of chronic negative
symptoms and disability (Schizophrenia Research, 2012)
IRIS Guidelines Update September 2012
Revision of the original 1998
IRIS Guidelines
www.iris-initiative.org.uk
[Cut to PDF of Guidelines]
Challenges
‘EIP is one of the keys to improving mental health services
and national mental wellbeing. The problem is that in these
times of intense spending pressures the incentives to invest
in these services risks being crowded out by much shorter
term pressures. Any decision to redesign community MH
services must draw on the evidence base and safeguard
the important functions and outcomes of EIP teams that
make them so effective’.
Steve Shrubb, NHS Confederation, Director of the MH Network, 2011
Better for Less?
• Cost savings are impacting on service
provision
• Tough decisions delegated to directorates and
teams
• Short term cost savings:
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Clumsy efficiency drives
‘Salami slicing’
Loss of leadership
Dumbing down
• Can we afford EIP in the current climate?
Potential Savings from Expanding EI services in England over next 20 years
Paying the Price: The cost of mental health care in England to 2026
Annual national savings (£ Million)
McCrone P, Dhanasiri S, Patel A, Knapp M, Lawton-Smith S Kings Fund 2008
National Coverage by EI teams
£5000 saved
per case/year
with EI teams
5,500 new
cases of
Schizophrenia/
year (Fearon
et al, 2006)
Assumes 50% coverage in 2008
Similar pattern with Bipolar Disorder
‘Early intervention is crucial to improving
outcomes. The Commission’s view is that
Early Intervention in Psychosis has been the
most positive development in mental health
services since the beginning of community
care. These services are popular with
service users and families and there is a
clear evidence of their effectiveness’
Schizophrenia Commission, November 2012
Summary
• EIP has not only transformed the lives of thousands of
young English people but has inspired and encouraged
leaders and professionals in many other countries to move
in the same direction.
• EIP has a clear and consistent evidence base, improving
outcomes and saving money if delivered in accordance
with the evidence.
• EIP does not describe an intervention but rather a
model of service and a philosophy of care.
• A specialist team model is most able to deliver clinical
and cost effectiveness. Success is closely related to
fidelity.
• We have come a long way but there is still further to go
The Future?
The future of the EIP reform may lie within a wider
and more ambitious reengineering of the health
system
• EIP into CMHT or CMHT into EIP?
• Providing early intervention and recovery within
a broad spectrum youth mental health model?
• Psychosis pathways and PBR?
• Integration?
• Prevention?
• Competition?
IRIS
• From a questionable acronym with modest
ambition
• To a new paradigm of genuine recovery for
those with the most serious MH problems
• By linking research, policy, activists, service
users and, vitally, service commissioners and
providers
THE ABANDONED ILLNESS
A report by the Schizophrenia Commission
http://www.schizophreniacommission.org.uk/the-report/
www.nhsconfed.org/Publications/briefings/Pages/psychosis-services.aspx
This briefing presents the evidence base and some key
considerations which may helpfully inform and provide a
focus for discussions between commissioners and
providers in the planning and delivery of community
mental health and early intervention in psychosis services.
http://www.iris-initiative.org.uk
@IRIS_Initiative
IRIS Guidelines Update September 2012
Revision of the original 1998
IRIS Guidelines
www.iris-initiative.org.uk