Pan-London Network for Psychosis-Prevention (PNP)

Abstract

Background: The empirical success of the Clinical High Risk for Psychosis (CHR-P) paradigm is determined by the concurrent integration of efficient detection of cases at-risk, accurate prognosis, and effective preventive treatment within specialized clinical services. The characteristics of the CHR-P services are relatively under-investigated. Method: A Pan-London Network for psychosis prevention (PNP) was created across urban CHR-P services. These services were surveyed to collect the following: description of the service and catchment area, outreach, service users, interventions, and outcomes. The results were analyzed with descriptive statistics and Kaplan Meier failure function. Results: The PNP included five CHR-P services across two NHS Trusts: Outreach and Support In South-London (OASIS) in Lambeth and Southwark, OASIS in Croydon and Lewisham, Tower Hamlets Early Detection Service (THEDS), City & Hackney At-Risk Mental State Service (HEADS UP) and Newham Early Intervention Service (NEIS). The PNP serves a total population of 2,318,515 Londoners (830,889; age, 16-35 years), with a yearly recruitment capacity of 220 CHR-P individuals (age, 22.55 years). Standalone teams (OASIS and THEDS) are more established and successful than teams that share their resources with other mental health services (HEADS UP, NEIS). Characteristics of the catchment areas, outreach and service users, differ across PNP services; all of them offer psychotherapy to prevent psychosis. The PNP is supporting several CHR-P translational research projects. Conclusions: The PNP is the largest CHR-P clinical network in the UK; it represents a reference benchmark for implementing detection, prognosis, and care in the real-world clinical routine, as well as for translating research innovations into practice.

Keywords: at risk mental state; prevention; psychosis; risk; schizophrenia; structured interview for psychosis-risk syndromes.

Figure 1

Pan-London Network for Psychosis-Prevention (PNP). Luton and Bedfordshire services were not included. K&C, Kensington and Chelsea; H&F Hammersmith and Fulham.

Figure 2

Pan-London crude predicted incidence of psychosis per 100,000 person-year (16-35 years). ^aNational average calculated from the PsyMaptic Psychosis LAD v1-0 xlsx file available at: http://www.psymaptic.org/prediction/psychosis-incidence-data/.

Figure 3

Cumulative risk of psychosis onset (failure function) in 787 CHR-P individuals from the Pan-London Network for Psychosis-Prevention (PNP). There were 503 individuals at-risk at year 1, 283 individuals at-risk at year 2, 192 individuals at-risk at year 3, 158 individuals at-risk at year 4, 139 individuals at-risk at year 5, 113 individuals at-risk at year 6, 110 individuals at-risk at year 7, 72 individuals at-risk at year 8, 42 individuals at-risk at year 9, and 29 individuals at-risk at year 10. The function was truncated at 4081 days of follow-up when 10 individuals were still at-risk for psychosis.