Driving improvements in care for people experiencing psychosis

UCL researchers have helped drive improvements in mental health rehabilitation services for people with complex psychosis, creating assessment tools now embedded in UK and international guidelines.

One in a hundred people experience psychosis at some point in their life. Around 20% will develop long term, complex problems that mean they require ongoing intensive interventions. Rehabilitation services support these patients to stabilise and reintegrate back into communities successfully, avoiding distressing and costly readmissions.  

Care associated with better outcomes  

A team led by Professor Helen Killaspy at UCL conducted major research programmes that have identified the components of mental health rehabilitation services that best support the recovery of people with complex psychosis. Their findings constitute the first empirical evidence base for contemporary mental health rehabilitation services since the 1970s.

Professor Killaspy and colleagues have developed standardised quality assessment tools for inpatient mental health rehabilitation services and mental health supported accommodation services. They have used these tools to identify the aspects of care associated with better outcomes in large patient cohorts. 

A standardised routine audit tool

The UCL-developed Quality Indicator for Rehabilitative Care (QuIRC; https://quirc.eu/) is an internationally standardised online quality assessment tool available in 11 languages and used by over 1000 services in 19 countries. It is recommended by the Royal College of Psychiatrists as a standardised routine audit tool for inpatient mental health rehabilitation and its quality improvement scheme, AIMS-Rehab. QuIRC is used by two-thirds of NHS inpatient mental health rehabilitation services.

The QuIRC-SA quality assessment tool for supported accommodation has been used in more than 150 services across England and Italy. Both QuIRC and QuIRC-SA are included in the first NICE Guideline for Mental Health Rehabilitation Services published August 2020.

Validation through large national studies

Professor Killaspy’s team used the QuIRC in a large cohort study of NHS inpatient mental health rehabilitation services across England to identify predictors of successful community discharge. Most patients had been in contact with mental health services for over a decade and experienced recurrent admissions before they were referred to rehabilitation services. Two-thirds of those who received rehabilitation achieved and sustained community discharge, without readmission. This was more likely in services with greater ‘recovery orientation’ (i.e. promoting collaborative working with patients, autonomy and hope).

Professor Killaspy’s team went on to assess how supported accommodation services contribute to the rehabilitation pathway through another national study. Using the QuIRC-SA,  they confirmed that services that were more recovery orientated, and those that promoted people’s human rights (e.g. enabling access to advocacy and legal representation), were more successful at helping people progress with their rehabilitation and ‘move-on’ to more independent accommodation, with associated cost savings for health and social care.  

Professor Killaspy was National Professional Adviser to the Care Quality Commission 2015-2020, driving a sea change in political support for investment in NHS mental health rehabilitation s services. As a result, NHS England set up the Getting It Right First Time programme to support Clinical Commissioning Groups (CCGs) to   invest in local mental health rehabilitation services for people with complex psychosis. 

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Links

• Professor Helen Killaspy’s academic profile
• UCL Division of Psychiatry
• UCL Faculty of Brain Sciences
• UCL Faculty of Brain Sciences REF 2021
• Improving provision of mental health rehabilitation services worldwide video

Image 

• Image credit: Pexels / cottonbro