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Early Intervention Service

  • Worcestershire's Early Intervention Service addresses the needs of young people (aged 14-35) with a first episode of psychosis or of bipolar disorder (specifically bipolar one). We also offer a time-limited intervention to young people with an At Risk Mental State (ARMS).

  • Address: Studdert Kennedy House Spring Gardens Worcester WR1 2AE New Brook Princess of Wales Community Hospital Stourbridge Road,  Bromsgrove,  B61 0BB,
  • Reception phone number: Worcester: 01905 734536 Bromsgrove: 01527 488440
  • Service hours: Weekdays - 9 a.m. - 5 p.m., with some flexibility as required (Out-of-hours support is provided from existing services. The service works closely with the Crisis Resolution and Home Treatment Teams who provide out-of-hours crisis support for Early Intervention Service Users as required).

About the service

The service works closely with a variety of other agencies:

  • Primary and Secondary Care.
  • Child and Adolescent Mental Health Services.
  • Education, Housing, Criminal Justice, Vocational, Advice and Advocacy Services

They assist individuals and their families in coping with the experience of psychosis/bipolar disorder, promoting optimal recovery and preventing further episodes of illness.

For more information on psychosis click here

For more information on bipolar disorder click here

The focus is on helping individuals to determine their goals and direction and Identifying the support needed to enable this including;

  • Provide information for young people, families and friends about their condition, coping strategies and medication.
  • Maximise the young person's control over their experiences and minimise disruption to the young person's life.
  • Provide psychological interventions on an individual and group basis.
  • Promote recovery from the episode and provide support during recovery.
  • Maintain and develop community connections.
  • Prevent or reduce the development of other problems such as depression, anxiety and lack of motivation.
  • Raise community awareness about psychosis and bipolar disorder and tackle stigma.
  • Sustain engagement with the young person for up to 3 years The emphasis is on working with the individual, family and friends to cope with the condition, promoting recovery, reducing trauma and avoiding stigma.

Getting help early

Psychosis

If you are concerned about someone who might be experiencing psychotic symptoms then it is important to seek help. With support, most young people with psychosis are able to get back to doing the things that they want to with their life. Sometimes, both families and young people with psychosis worry that others will not understand what is happening to them or will not be able to help. The Early Intervention Service is set up for this reason; to help young people with psychosis and their families. Putting off getting help can lead to the young person with psychosis feeling alone and down.

 

Bipolar disorder

Earlier recognition of Bipolar Disorder is important. Delays in getting the correct diagnosis and treatment can lead to more personal, social, and work-related problems.  Early treatment helps most people to stabilize the mood swings and reduce the frequency and severity of episodes and enables people to get on with their lives. Medication can be very effective in controlling mania and preventing the recurrence of both manic and depressive episodes. Early intervention will also include providing information, support, education, and guidance to the young person and their family to aid understanding and coping.

What we do

Individual Support

Each young person and their family will be allocated a Case Manager or contact person. A Case Manager is a professional who is responsible for the co-ordination of a range of services to meet the needs of young people with psychosis/bipolar disorder and their families. The Case Manager can also help the young person make plans for their future and will provide links/liaison with work, education, health and community support agencies.

 

Family Support

The service understands that psychosis and bipolar disorder can have a major impact on a young person's family. The service is committed to providing families and friends with information about the condition and support. A range of services are provided to meet these needs, including:

  • Individual sessions.
  • Family sessions.
  • Access to family/friends information groups.

 

Community Liaison

The service aims to ensure close links and continuity of care with a variety of community and specialist support agencies. This includes helping the individual to access accommodation, specialist counselling, educational and vocational support, advice and advocacy services, as well as liaising with GPs, schools, employers and other support agencies as appropriate.

At Risk Mental State (ARMS)

What is an At Risk Mental State (ARMS)?

At risk mental state (ARMS) is a term which is used by health professionals to describe young people, aged 14 – 35 years, who are experiencing perceptual changes that may be early, low level, signs of psychosis. It is unusual for psychosis to just happen. There are more likely to be some early signs weeks or months beforehand. So, Mental Health Services are now trying to work with young people when they are at risk. The idea is to delay the onset of psychosis, or even stop the experience of a first episode of psychosis altogether.

There are three groups of people who may be said to have an ARMS:

  1. People with short-lived or milder symptoms of psychosis within the last 3 months.
  2. People who have been functioning less well over the last 12 months. For example withdrawing from school, college or work or not being able to spend time with family or friends. On its own not functioning so well may be due to something else. But if you also have a brother or sister or a parent who has experienced psychosis this could mean you are having an ARMS.  
  3. People who experience brief limited intermittent psychotic symptoms (BLIPs). These are psychotic level symptoms that have naturally stopped within 7 days.

They may start to have more unusual experiences; perhaps seeing things that other people don’t or hearing sounds which aren’t really there. These experiences may become frightening and distressing.

Who may have an ARMS?

Most often it is young people between the ages of 14 – 35 years who can have an at risk mental state. Research from young people who have had a first episode of psychosis suggests that they had a short period (3-6 months) of early psychotic experiences before they became more seriously unwell.

What causes someone to have an ARMS?

There is no one single cause. Generally people become at risk of psychosis due a mixture of stress factors and vulnerability. Like many mental health difficulties there are biological influences (genetics, chemicals in the brain), social influences (relationships, family) and psychological factors (beliefs about self and others). Currently, research suggests that about 1 in 3 people who are at risk may become more unwell in the future and experience a first episode of psychosis.

Other risk factors include:

  • Higher levels of stress
  • Feeling increasingly worried or anxious
  • Major life events e.g. changing school, starting college, break up of a relationship, family problems, bereavement etc.
  • Using substances e.g. cannabis, ecstasy, LSD, MCAT, amphetamine, cocaine.
  • Childhood abuse or neglect.

What kind of experiences could someone have?

  • Feeling tense, afraid and worried (anxious).
  • Racing thoughts (too many at once, not able to focus on one thought at a time).
  • Feeling more quiet and withdrawn
  • Not socialising or seeing friends
  • Feeling depressed, low, irritable and restless
  • Feeling puzzled about strange experiences
  • Having a reduced appetite and losing weight
  • Having difficulty sleeping/broken sleep
  • Becoming more self-conscious or nervous in public places

 Young People who are ARMS might have only one or two of these experiences but it is possible to have several of them at once and they can become confusing and distressing.

Why is it important to seek help for an ARMS?

For many people these experiences are short-lived. They are often a reaction to stress and will stop without any help or intervention by mental health services. However, for about 1 in 3 people, they may last for a longer period of time and could lead to a further, more serious, first episode of psychosis. If someone is reporting ARMS difficulties and would like some help, they can contact the Early Intervention Service. The Early Intervention Service will offer an assessment and support if needed. Alternatively, they can ask a family member to get in touch or go to see their GP.

What can services offer young people with an ARMS?

The risk of psychosis is linked to stress and vulnerability. So it is always best to get help sooner rather than later. This can stop the experiences from getting more distressing. The young person can get an explanation and information as to what is happening. They may be provided with self-help information, or signposted to another more appropriate service to help with their presenting difficulties. Other people will receive more targeted support from the Early Intervention Service for a 6 – 12 month period.

How to refer

To meet criteria for an At Risk Mental State (ARMS) for psychosis, the individual needs to be presenting with distress/difficulty/functional decline in the last 12-months (for which they are help seeking), and also one of the following:

  1. Attenuated symptoms – overvalued ideas or perceptual disturbances at the ‘extreme end of normal limits’ – these may be experiences/thoughts etc which can be easily dismissed or do not significantly affect behaviour. Duration = at least one week but not longer than five years, Frequency = at least twice per week and Recency = in the last year.

  2. Brief Limited Intermittent Psychotic Symptoms (BLIPS) – fully formed psychotic symptoms which either resolve spontaneously within seven days (without treatment), or occur very infrequently (less than twice per week). These can be drug triggered and recency needs to be within the last year.

  3. Family History – Family history of psychotic disorder in a first degree relative or schizotypal personality disorder and presenting with non-specific symptoms eg mood, anxiety problems and a significant decline in functioning. Duration = at least one week but not longer than five years.

EI screening checklist [doc] 29KB

EI: DUP MHMDS Worcs data calculation form [docx] 19KB

Early Intervention Operational Policy [docx] 110KB

EI Service specification [docx] 72KB

ARMS flowchart [doc] 37KB