REINHARD HEUN PROFESSOR OF PSYCHIATRY RADBOURNE UNIT RDH DERBYSHIRE HEALTHCARE FT KEGWORTH, 1 APRIL 2014 What works well in the treatment of psychosis

Patient history 45 year old male Schizophrenia since age 22 Transponder in his head Thought transmission and broadcasting Severe ideas of reference Poor compliance, many hospital admissions Strong beliefs and feelings of reality Unpleasant side effects

Patients urgent needs Acute support Protection Understanding of condition Understanding by relatives Support in everyday life Hope for improvement Medication that works A vision for a healthy and active future Time to be listened

Patients long-term needs Partner, friends and family Financial security Integration into society Useful activities and occupation Undisturbed creativity Undisturbed sex life Settling into the situation Monitoring of medication Monitoring of side-effects

Main services available Outpatients clinics Crisis and home treatment teams In-patient services Community mental health teams Recovery clinics Early intervention team Assertive outreach team Psychological services Social services Occupational therapy

Positives for the individual patient Good communication with therapist Good motivation to get better Good motivation to take medication Motivation to do art work Drops into OPC when needed Willingness to try new medication Willingness to be active Vivid hope that cure is possible Avoidance of hospitalisations

Positives in the service Flexibility to meet the patients needs Open door policy Availability of a variety of services People who understand the disease People who value and understand the person People who can support the family

Commissioning consideration I (patient related) Urgent and long-term needs Considerable co-morbidity Diagnostic overlap Change in clinical presentation Need for continuity Trust needs time High patient and family expectations

Commissioning considerations II (population related) High variance in patient presentations High variance in support needs More fringe/ sub-threshold than typical disorders Treatable and treatment-resistant disorders High variance in referrals Focus of primary vs. secondary care in mental health

Commissioning considerations III (service related) Primary versus secondary prevention NICE guidelines Paradoxical economy in outcome:  more difficult, more effort, less benefits General vs. specific services 24/7 services