Optimising the delivery of 'Early Intervention in Psychosis' - a mixed methods study.
File(s)
Author(s)
Williams, Ryan
Type
Thesis
Abstract
Early Intervention in Psychosis (EIP) services are widely regarded as a best-practice approach for supporting people in the early stages of psychosis and consistently produce better outcomes than standard care. However, it remains unclear which specific components of EIP drive these improvements. This thesis addresses this gap by identifying the elements of EIP care most strongly associated with positive outcomes and exploring the mechanisms through which they operate.
I used a mixed-methods design combining quantitative and qualitative approaches across four linked work-packages.
In work-package one, I conducted a systematic review and component network meta-analysis of 37 randomised controlled trials of EIP. Intensive case management and psychological interventions were associated with improved symptoms and social functioning when delivered alongside pharmacotherapy.
In work-package two, I analysed cross-sectional data from a national survey of 2,374 EIP service users. Smaller care-coordinator caseloads, cognitive behavioural therapy for psychosis (CBTp), and family or carer interventions were associated with better experiences of care.
In work-package three, I linked case-note data from a national audit of 14,874 EIP service users with routine outcomes from NHS England to conduct a three-year retrospective cohort study. Smaller care-coordinator caseloads and clozapine use among eligible individuals were associated with fewer relapses, while CBTp and physical-health interventions were linked to improvements in secondary outcomes.
These findings informed work-package four, a qualitative study involving interviews with 45 service users, carers, and healthcare professionals from six purposively sampled services with varying caseload sizes and admission rates. Four themes emerged: continuity, flexibility, inclusivity, and co-production.
Together, these studies suggest that improving EIP outcomes requires both reliable access to key interventions and delivery models that support relational, person-centred practice, providing guidance for policymakers, commissioners, and clinicians seeking to maximise the impact of EIP services.
I used a mixed-methods design combining quantitative and qualitative approaches across four linked work-packages.
In work-package one, I conducted a systematic review and component network meta-analysis of 37 randomised controlled trials of EIP. Intensive case management and psychological interventions were associated with improved symptoms and social functioning when delivered alongside pharmacotherapy.
In work-package two, I analysed cross-sectional data from a national survey of 2,374 EIP service users. Smaller care-coordinator caseloads, cognitive behavioural therapy for psychosis (CBTp), and family or carer interventions were associated with better experiences of care.
In work-package three, I linked case-note data from a national audit of 14,874 EIP service users with routine outcomes from NHS England to conduct a three-year retrospective cohort study. Smaller care-coordinator caseloads and clozapine use among eligible individuals were associated with fewer relapses, while CBTp and physical-health interventions were linked to improvements in secondary outcomes.
These findings informed work-package four, a qualitative study involving interviews with 45 service users, carers, and healthcare professionals from six purposively sampled services with varying caseload sizes and admission rates. Four themes emerged: continuity, flexibility, inclusivity, and co-production.
Together, these studies suggest that improving EIP outcomes requires both reliable access to key interventions and delivery models that support relational, person-centred practice, providing guidance for policymakers, commissioners, and clinicians seeking to maximise the impact of EIP services.
Version
Open Access
Date Issued
2025-09-29
Date Awarded
2026-04-01
Copyright Statement
Attribution-NonCommercial 4.0 International Licence (CC BY-NC)
License URL
Advisor
Crawford, Mike
Bottle, Alex
Weaver, Timothy
Sponsor
National Institute for Health Research (Great Britain)
Grant Number
NIHR302320
Publisher Department
Department of Brain Sciences
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)