Early Intervention in Psychosis (EIP) services in mental health are able to save up to £40 million a year.
This 'invest to save' approach can begin to release savings even within the first year of service provision.
Cost savings can be quantified within the health sector as well as across wider society.
New research demonstrates the significant social and economic benefits of the EIP model in reducing unemployment and suicide.
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A London School of Economics and Political Science (LSE) and King's College London study has shown that by providing an early intervention service approach rather than standard mental health care for one cohort of patients with psychosis, the UK could save £40 million per year in the short term, £33 million in the medium term and £18 million in the long term.
England have arguably been world leaders in the development of this innovative service approach and its evidence base over the last ten years. As with other conditions like cancer and heart disease, EIP reflects a shift to a more responsive specialist service geared to the early phase of the illness. Furthermore the service model overcomes a major criticism of traditional services in being more able to work effectively with young people and their families particularly across the transition from child to adult services, recognising that the typical age of onset for psychosis is between 14-35. Apart from improving speed of access and reducing traumatic hospitalisation in crisis, the service aims to reduce disruption in other areas of patients' lives, maintain them in employment, education or training as appropriate, improve access to treatments and work with the whole family to reduce the burden for carers.
Research has previously shown that EIP can lead to a decrease in the frequency and severity of relapses, and faster recovery. It has been shown to have clinical and social benefits. Cost modelling has also indicated substantial cost savings within and beyond the NHS.
Professor Louis Appleby (Birmingham, 29 April 2009) in a reflection on the achievements of the National Service Framework, described EIP as the 'jewel in the crown of the NHS mental health reform because firstly service users like it, secondly people get better and thirdly it saves money'.
However earlier cost modelling studies focused on psychiatric service costs rather than examining the impact on other services and lost employment. This new series of models, funded by the Department of Health and commissioned via LSE Enterprise, additionally considers the cost of lost employment and suicide. In addition, the long-term impact of EIP is explored. EIP provision results in more people being in work than when using standard services and the models suggest that the value of extra production is around £2,000 per service user. This analysis assumes a minimum wage and so is likely to be an underestimate.
People experiencing psychosis are at high risk of suicide. The lifetime risk is up to 10% and risk is greatest early in the illness, with more than half of all suicides occurring within the first five years. This can be reduced when EIP is provided; the number of suicide attempts in areas with EIP teams is one third of that in areas without them. Looking at NHS costs, productivity losses and the reduced quality of life in those who are bereaved, the annual costs due to suicide are estimated to be £460 per person accessing EIP services compared to £1,417 for those accessing standard care services.
This new economic model anticipates that in the short term the effects are on service use and employment, predicting that the savings due to EIP are around £50 million per year. In the long term the model assumes that the savings in service costs do not continue, but those due to employment gains and reduced costs from suicide would continue to provide savings of around £20 million per year at a conservative estimate.
LSE professor Martin Knapp, director of the Personal Social Services Research Unit (PSSRU) and the National Institute for Health Research School for Social Care Research, worked with Professor Paul McCrone from the Institute of Psychiatry at King's College London and A-La Park of PSSRU on this study.
Professor McCrone says, 'These models clearly indicate that there are economic savings to be gained as a result of early intervention services. Given that they also have clinical and social benefits on an individual patient level as well as a service and sector wide level, they represent good value for money to the NHS. It makes good economic sense to safeguard these services as costs would increase were they not there.'
Paul Jenkins, Chief Executive of mental health charity Rethink, says: 'Early intervention is the most exciting development in mental health services in the last 20 years. It has transformed the lives of those newly developing a serious mental illness and this study clearly supports the economic case for extending this approach further.'
Sarah Brennan, Chief Executive of the young people's mental health charity YoungMinds, says: 'These are very important findings which should influence the way we commission and deliver all services for children and young people needing mental health support and services, in particular in the new commissioning environment. The research clearly shows how the early intervention model enables everyone to benefit. It is essential we build on this approach in future.'
Mothers of EI users give their views.
'In the early days after my youngest son became ill with psychosis, I felt that I was at the bottom of a very, very deep well with no sight of light at the top. But we were lucky in that our GP made a very quick referral to the Child and Adolescent Mental Health Services and after a few months of intensive support and a diagnosis of bi-polar disorder by them and an Adolescent Unit, L was referred to the Worcestershire Early Intervention Service. They involved the whole family in L's recovery right from the start.
'Now he is about to start university, after managing to achieve mainly A* and A grades in his GCSEs and A levels despite his illness, long absences from school and the side effects of his medication. His hopes for the future are back thanks to the outstanding help and support he has had throughout his illness. Earning a place on a Masters degree in Physics with Particle Physics and Cosmology at the University of Birmingham is pretty hard evidence that the early intervention and family therapy has been worth any extra initial cost to the NHS.'
'All of my life I have lived with people with mental illness. Two brothers and my father suffered from schizophrenia. I grew up with no understanding of their illness and as a family we all suffered. When my son started to hear voices and hallucinate I thought that like my father and brothers his life was over and he would never be an active part of society. Then we were introduced to the early intervention team and all of our lives changed for the better.
'Ed is a very active member of society, has passed his GCSEs and now has a GNVQ in horticulture. He was Horticulture Student of the Year and is now at college continuing his studies. I feel that a chain was broken in our family that had gone on for many years, and without early intervention we would still be living under that black cloud.'
Jill Hewitt, 2009 (Visit www.iris-initiative.org.uk/gp-commissioning/ to hear Jill and her son describe their experiences of EIP services.)
NOTES FOR EDITORS
This study was commissioned by the Early Intervention Programme, part of the National Mental Health Development Unit's Improving Care Pathways programme.
The study was managed by LSE Enterprise, which offers a professional interface with LSE's academic departments, institutes and research centres. To find out more, see lse.ac.uk/enterprise
EIP service development followed demands from service users and families for services that could better meet the needs of young people in the critical early phase of the disorder. This has been one of the most promising specialist mental health service developments of the last ten years and is now the norm in England and beginning to appear in other parts of the UK. We now know that when even good quality 'standard' mental health services are compared with EIP services, the latter report quicker access, lower use of legal detention, reduced hospital admissions, lower relapse rates, better recovery, better service engagement and client/carer satisfaction and lower suicide rates. To find out more, visit the National Mental Health Development Unit EIP site: www.iris-initiative.org.uk.
Rethink is the leading national mental health membership charity, working to help everyone affected by severe mental illness recover a better quality of life. See www.rethink.org for more information.
YoungMinds is the voice for young people's mental health. See www.youngminds.org.uk for more information.
To contact Martin Knapp or Paul McCrone, email Rehanna Neky at LSE Enterprise: firstname.lastname@example.org.