Profile and activities of a rural home-based psychiatric treatment service in Ireland

Home-based treatment has been promoted as an alternative to hospital admission over the last 30 years, with the system in England being particularly well developed. There is less stigma, patients and families appear to prefer treatment at home, and there has been a significant reduction in the number of acute beds. In more recent years, there have been criticisms of the lack of effect on reducing hospital admissions and concerns have also been raised about patient safety. Home-based treatment is being further developed on the island of Ireland, and this will hopefully be influenced by current and future local research.

Section: Irelandmentioning

confidence: 85%

Progress in home-based treatment

McGarry¹

2018

“…Fundamental to CAMFEPS was a model based on a registrar/clinical research fellow having both sessional service commitments and a research role via embedding within CMMHS. Thus, he/she was integral to CMMHS, in which primary care liaison and use of home-based treatment as an alternative to hospital admission are central to the delivery of mental health services (McCauley et al 2003;Russell et al 2003Russell et al , 2019Nwachukwu et al 2014). In 2009, during which CAMFEPS was completing its 15-year tenure, CMMHS took the decision to establish COPE as Ireland's first rural-based EIS.…”

Section: Development and Operationmentioning

confidence: 99%

Carepath for overcoming psychosis early (COPE): first 5 years of clinical operation and prospective research in the Cavan–Monaghan early intervention service

Fayyaz

Nkire

Nwosu

et al. 2021

Objectives: As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan–Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation. Methods: COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016. Results: During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder. Conclusions: COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.

“…These two studies operated in parallel for four years, after which the St. John of God Hospitaller Ministries/Cluain Mhuire Community Mental Health Services study began a process of evolution into the Dublin and East Treatment and Early Care Team (DETECT) early intervention service (Renwick et al 2008), while CAMFEPS continued for a total of 15 years, during which it evolved into the Carepath for Overcoming Psychosis Early (COPE) early intervention service (Nkire et al 2015), as outlined below (see Early intervention) and elaborated in a companion article (Russell et al 2019). The structure of CAMFEPS involved a Clinical Research Fellow/Registrar embedded within CMMHS and having both a research role and sessional service commitment; the service model involved two community mental health teams, a specialist service for the elderly and a community rehabilitation team, with primary care liaison and use of home-based treatment as an alternative to hospital admission being central to the delivery of health services in this model (McCauley et al 2003;Nwachukwu et al 2014; see Russell et al 2019).…”

Section: Outline Of Camfepsmentioning

confidence: 99%

“…These findings relate to studies carried over a period during which the underlying model of mental health care provision, in which CAMFEPS was embedded, has been progressively revised. This journey, involving primary care liaison and use of home-based treatment as an alternative to hospital admission as central to the delivery of health services (McCauley et al 2003;Nwachukwu et al 2014), is described in detail in a companion article; the challenges encountered and opportunities afforded in the course of these innovations are instructive, both locally and nationally, when considered in the context of current professional, public and political debate (Russell et al 2019).…”

Section: Functional Outcome and Service Modelsmentioning

confidence: 99%

The Cavan-Monaghan First Episode Psychosis Study (CAMFEPS): arbitrary diagnostic boundaries across the gene–environment interface and within evolving models of care

Waddington

Russell

2019

Self Cite

As research into psychotic illness evolves along established lines, insights are emerging that deviate from those lines and challenge more fundamentally our understanding. On the background of a new generation of studies on first-episode psychosis, investigations across the gene–environment interface and the intersection with ‘normal’ human mentation heighten these concerns. Using findings from the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS) as an exemplar, we here review the complexity of these challenges from the perspective of this real-world setting. They range from trans-diagnostic epidemiology and clinical characterisation, through molecular genetics, social milieu, developmental pathobiology and functional outcome across arbitrary diagnostic boundaries, to the evidence base for early intervention and more radical conceptualisations and structures for provision of mental health care.