Setting

The most suitable setting for this audit is a service for early intervention in psychosis, although it could be done by any service caring for people with schizophrenia.

Background

Early intervention teams provide assessment and treatment for all first episodes of psychosis for patients aged 14–35 years, many of whom will be completing their education, thinking about further education or seeking employment. The local team has an occupational consultant who links with a partner organisation offering educational and occupational support for people with mental illness or intellectual disability.

Standards

The 2009 guideline for schizophrenia from the National Institute for Health and Clinical Excellence (NICE) set the following standards:

ᐅ Mental health services should work in partnership with other organisations to enable people with schizophrenia to access local employment and educational resources.

ᐅ The daytime activities of people with schizophrenia should be routinely recorded, including ‘occupational outcomes’.

ᐅ Early intervention services should offer a full range of interventions, including occupational and educational interventions.

ᐅ ‘Supported employment’ programmes should be provided for people with schizophrenia who wish to work. However, they should not be the only work-related activity offered when individuals are unable to work or are unsuccessful in their attempts to find employment.

ᐅ All service users with schizophrenia, or in this case first-episode psychosis, should be offered an assessment of occupational and/or educational needs and aspirations, and the service should help them to achieve the desired outcome.

Method

Data collection

The service was still fairly new when audited, so it was possible to obtain a list of all patients taken on by the team (a total of 40). Those who had received an assessment with the occupational consultant had a file held at the partner organisation. The initial assessment paperwork was located in these files and contained information on baseline aspirations. For those whose baseline aspirations had been recorded, information was obtained regarding achievements after 6 months and 1 year. For those who did not have a file, the case notes were accessed on the computerised records system to find out whether there was any documentation regarding the reasons for not having had an occupational assessment.