Multi-Disciplinary Working & The NHS Plan Pleasures and pitfalls from a secondary perspective

1. Multi-Disciplinary Working & The NHS PlanPleasures and pitfalls from a secondary perspective P.B.Jones Department of Psychiatry University of Cambridge

3. Multi-Disciplinary Definitions

5. Multi-Disciplinary • Definitions • Multi- or inter-disciplinary • An obvious concept • it doesn’t always work • but if it does work, it’s “un-stoppable”

6. Multi-Disciplinaryin Mental Health Services

12. Multi-disciplinary and mental health go hand-in-hand • No more or fewer pitfalls than in uni-disciplinary work…. • … and who’d want to do that..? • Neither should we lose our disciplines or our leaders

13. Who are the disciplines in mental health?

14. Multi-Disciplinary Working • A case study of catalysis • Early intervention in psychosis

15. A plan for investment A plan for reform Presented to Parliament by the Secretary of State for Health By command of Her Majesty July 2000

16. Early intervention in psychosis 14.30 Early intervention to reduce the period of untreated psychosis in young people can prevent initial problems, and improve long-term course fifty early intervention teams will therefore be established over the next three years to provide treatment and active support in the community to these young people and their families by 2004 all young people who experience a first episode of psychosis, such as schizophrenia, will receive the early and intensive support they need. This will benefit 7,500 young people each year

17. The Syndrome of Psychosis • Hallucinations Perception • Delusions Inferential thinking • Disorganized speech Language • Bizarre behaviour Self-monitoring • Alogia Conceptual fluency • Affective change/blunting Emotion expression • Anhedonia Pleasure experience • Avolition Will or volition • Movement disorder Extra-pyramidal ` control after Nancy Andreasen 1995

18. Disabilities • Primary Symptoms and cognitive problems, treatment side effects • Secondary Loss of education, family, friends, job, relationships SOCIAL CAPITAL • Tertiary Stigma, lost opportunities

19. Epidemiology • 20 new cases per 100k per year • Age 15 - 55 • Younger less social capital and more severe illness • More men than women • Increasingly “co-morbid” with drugs • Very long delays before treatment and complex pathways to appropriate care

20. Outcome • At least a half do unacceptably poorly and accrue secondary disabilities • 10 per 100K per year • Long duration of untreated psychosis - poor outcome • Poor engagement with services - poor outcome

21. Prompt & proper treatment of psychosis • Reducing the DUP / DUI is a key target • What’s the logic?

22. Duration of Untreated Psychosis/Illness • Three putative damaging mechanisms • Psychosis is neuro-biologically toxic • Psychosis has psychological sequelae (c.f. PTSD) • Accumulation of secondary disabilities • All three are probably important • Something in this for all disciplines

23. Duration of Untreated Psychosis/Illness • Three putative damaging mechanisms • Can be shortened by earlier detection and prompt intervention, but the systems are complex • Many disciplines involved • Unity is driving this forward

25. This is not rocket science • Disciplines working together are an unstoppable force for change • Pitfalls often in out-of-date teaching (teachers) and practitioners, not front-line clinicians • But…..

26. “StBOP” • The team has new members • Users • Carers • Primary Care • New challenges for all sides: clinical, research and teaching

27. Conclusions • M-D working is normal • why are we even talking about it?! • No more pitfalls in M-D working than in any other style • Can be spectacularly successful & pleasurable • NHS plan • New kids on the block • pleasures will be linked to the challenges

28. Skw22@medschl.cam.ac.uk