Psychosis HIT reflects on 2021-22

Work related to improving the support, treatment, services and lives of local people with psychosis has been ongoing, thanks to Bristol Health Partners core team support. This has been hugely beneficial in maintaining momentum, enabling collaboration on research projects, and providing public contributor and lived experience input to the development of system-wide Serious Mental Illness project, the P Risk study, and in identifying other opportunities.

As a HIT we have convened and been working with a Lived Experience Advisory Panel (LEAP) that includes service users and carers with lived experience of psychosis. HIT Director James Robinson leads the group, with Harminder Kaur and has advised on the P Risk study as well as other work on the effect of oestrogen on risk of psychosis in older women. The HIT has brought together an African and Caribbean heritage LEAP which has advised on the inequalities involved in psychosis diagnosis, and has undertaken a literature review of evidence of race inequality in Assertive Outreach team caseloads.

The LEAP has advised on the sensitive communication of psychosis risk by the GP, which has been calculated using a data-based risk algorithm. The LEAP also confirmed the importance of work on the role of sex hormones in psychosis and several female members confirmed a late onset of psychosis and the problems that they had had with diagnosis and receiving the right help.

HIT Director Simon Downer has brought national and international links to our HIT through being a Trustee the International Society for Psychological and Social Approaches to Psychosis (ISPS UK). Last year they were involved in a series of webinars, and are developing a film about institutional racism in psychiatry and a new website to provide resources for people within mental health services and outside.

Simon was also named as Principal Investigator for the RADAR Trial – a multi-centre randomised controlled trial looking at reduction in antipsychotics for people with long-term psychosis who are in secondary mental health care.

The “P-Risk” study supports more accurate early identification of psychosis risk to avoid escalation of poor health outcomes and use of services. ‘P Risk’ is an algorithm to predict risk of psychosis using primary care electronic health records of consultation history and sociodemographic variables. The development and validation work for ‘P-Risk’ algorithm has now been completed. A paper on development has been successfully submitted to Schizophrenia Research.

We have held several useful patient and public involvement events in advance of a successful outline application in March 2021 to the NIHR Research for Patient Benefit funding programme. Our full application with Sarah Sullivan as PI and Simon Downer and James Robinson as co-applicants and with University College London (UCL) as a study partner was successful and a 14 month implementation and feasibility study for P Risk will be funded. Initial meetings have been held with collaborating organisations OneCare, Bristol, North Somerset and South Gloucestershire (BNSSG) Clinical Commissioning Group and health records systems supplier EMIS.

We have made fruitful links with the Bristol, North Somerset and South Gloucestershire Mental Health, Learning Disabilities and Autism Programme, and the Adversity and Trauma HIT, with joint work planned for 2022.