Departure from Psychosis services

This was my last week working for the NHS and sadly I have to acknowledge that I am glad to be leaving . I have found the latter part of my last 7years in Early Intervention in Psychosis Services to have been difficult and stressful. The extremely restrictive commissioning effecting EIS services in my own area of South East England has precluded innovative practice and the implementation of Open Dialogue in Psychosis Services. Commissioning in some of the London Trusts has been more creative but in Kent, Surrey and Sussex we were restricted by the rigidity of the guidelines. We were also in Kent prevented from proceeding at the same pace as our two Trust partners because there was a 3-year delay in KMPT receiving the money to expand services. We were, therefore, unable to extend our age range from 35 to 65 because we did not have the funding in place to cover the cost of additional staff.

I had originally imagined that the additional money made available to Early Intervention Services would result in a huge expansion and greater variety in what we would be able to provide the service users and their families. I had believed that I would be able to expand psychological therapies to cover a wide range of therapeutic interventions incorporating psychotherapy, CBT, EMDR, group work and some of the more creative therapeutic approaches, which are advocated by the NICE guidelines and research. There have been Early Intervention Services that have used creative therapies to benefit clients in some of the London Trusts and we have had a trainee art psychotherapist on a 2 year placement who has been able to work with service users who have not responded to CBT. Unfortunately, we were unable to expand services and due to the restrictions of commissioning were only able to employ CBTp therapists whom had no p (psychosis) training and are still waiting for the training to be put in place by NHS England.

I had also presumed that we would with the additional money be able to provide an Open Dialogue training and use the approach to provide an alternative to Behavioural Family Therapy. The feedback we get in services is often that clients and service users find BFT with it’s modular delivery quite restrictive and prescriptive. We have managed to use Family Conversation an approach which is not dissimilar to Open Dialogue and which a few members of the team have been trained in. Once again unfortunately we were not able to take advantage of the training which members of the team had already received in Open Dialogue and use this to provide an alternative intervention. Subsequently my last few years as operational lead have been extremely frustrating.

About Author: I am Jane Hetherington Principal Psychotherapist and Operational Lead with Early Intervention Services in Kent. I trained as an integrative psychotherapist and have worked in substance misuse, primary care and psychosis services. I have completed the Open Dialogue training and will be involved in the new Open Dialogue Service, in addition I am on the APOD UK Board and completing the International Train the Trainer Open Dialogue course in Helsinki.