Refer for assessment immediately
A national access and waiting time standard for first episode of psychosis was introduced on 1 April 2016, with the requirement for atleast 50% of people being seen in the first two weeks. NHS England has committed to ensuring that by 2020/21, the standard will be extended to reach at least 60% of people experiencing first episode psychosis.
If you suspect someone may be experiencing a first episode of psychosis, it is important that you refer that person to their local mental health trust for assessment immediately.
The recently developed mental health dashboard shows numbers of referrals in all areas, and percentages of teams meeting their targets.
What does psychosis look like?
What should GPs ask patients?
If you suspect psychosis is a possibility, it’s important to act promptly and refer for assessment immediately
1. Ask questions such as:
- Have you been feeling, seeing or hearing things that other people can’t?
- Have you been feeling anxious or panicky?
- Have you been feeling that people are talking about you, watching you, or giving you a hard time for no reason?
- Are you worried about your safety when you’re around others?
- Have you been spending more time alone and having trouble sleeping?
2. Look for physical illnesses such as:
- Drug/substance intoxication (frequent co-morbidity in first episode of psychosis)
- Liver dysfunction
- Systemic dysfunctions
- Nutritional deficiencies
- CNS abnormalities
- Metabolic disorders
If a person is experiencing any of these symptoms, refer them to their local mental health trust for assessment of possible first episode psychosis.
3. Assess your patient for risk.
Self-harm is more common in the early phase of psychosis. Evidence shows that the risk of suicide drops from 15% to 1% when a person with a first episode of psychosis receives early intervention treatment.
Watch – detecting first episode psychosis
Watch this two-part video, produced by the Iris Initiative, about early detection of psychosis in primary care,
- Early detection of psychosis in primary care – Part One
- Early detection of psychosis in primary care – Part Two
Referring a patient with possible psychosis for assessment
Every borough has different processes for referring people with a possible first episode of psychosis for assessment. Please refer to the borough map for contact details for London’s mental health trusts.
Primary Care learning guidance and fact sheets
These tools have been endorsed by the Royal College of Psychiatrists and the Royal College of General Practitioners.