Transforming Management of Psychosis


young men10,000 young people in England every year are diagnosed with a psychotic disorder.

Our research has transformed their management by informing national and international bodies on the need for early treatment and on recognition of depression in early psychosis and schizophrenia and, particularly the need to identify and treat depression in this early phase. It highlighted how delays in accessing treatment at the onset of psychosis could be avoided. This led to an NHS standard on “Access and Waiting Times” for Early Intervention Services (EIS) in psychosis, reducing treatment delays by over 150 days.

How will understanding early immune dysfunction improve outcomes for young people with psychosis? with Professor Rachel Upthegrove


About the Project

The University of Birmingham’s research in mental health of the young has reformed service provision, policy and practice. The impact of this work extends both nationally and internationally, and with significant improvements for service users. 

In 2015 the NHS report Five Year Forward View on Mental Health included access and waiting time standards for first episode psychosis, with all patients presenting with first episode psychosis referred and managed by NHS Early Intervention Teams.  Having established that delay in treatment at the onset of psychosis could be more than halved by improving access to early intervention services (EIS), Birchwood was invited to be a special advisor to the NHS England (NHSE), helping to develop the 2016 Implementing the Early Intervention in Psychosis Access and Waiting Time Standard: Guidance. All EIS teams must now monitor access times in line with the guidance. 

Impact and Results

Since this monitoring was introduced, three quarters of EIS team in psychosis now deliver NICE care within two weeks of the patient’s referral (June 2018) compared to one third in June 2015. With approximately 10,000 new cases of psychosis in England per year, the care of about 7500 has been improved by these changes, and their treatment delay reduced by more than half, from an average of 285 to 105 days. 

With an annual incidence of 32 per 100,000 population, and a population of 53 million, around 17,000 new young people every year in England alone have their care informed by these guidelines. Hence the Birmingham-led research has also had significant impact for least 957,000 people living with schizophrenia in the UK. 

Upthegrove’s program of research has also informed international prescribing which now include a detailed section on the need to recognise and manage depression in early psychosis and schizophrenia to prevent suicide and improve outcomes. The British Association for Psychopharmacology (BAP) is the largest psychopharmacology association in Europe, and the second largest in the world. BAP guidelines are consensus statements used by practicing psychiatrists around the world, with downloads of the guidance freely available and accessed over 6000 times every year. Professor Upthegrove co-authored the BAP Guidelines on the treatment of Schizophrenia. The majority of practicing psychiatrists (over 5000 consultant psychiatrists in the UK alone together with members of the Royal College of Psychiatrists in Canada, Australia and Asia) use Advances and BAP resources to inform their clinical management. Their prescribing practice of antidepressants in first episode psychosis has been informed by the 2018 multicentre trial and patients should no longer be ineffectively treated with Minocycline.

In addition to informing BAP guidelines, Professor Upthegrove has provided expert input on the treatment of psychosis for the Pocket Prescriber for Psychiatrists, written in association with the BAP. 

Birmingham Heroes: Dr Rachel Upthegrove talks Youth Mental Health




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