Individual research recommendation details

Recommendation ID

NG181/1

Question

What is the efficacy and cost effectiveness of rehabilitation services compared with treatment as usual for people with complex psychosis with residual disability, who are leaving early intervention services?

Any explanatory notes
(if applicable)

Why the committee made the recommendation

Low to very low quality evidence from randomised controlled trials of rehabilitation in the community and observational studies of inpatient rehabilitation showed that rehabilitation was effective and cost effective for many people with complex psychosis. Qualitative evidence also showed that people with severe mental illness value rehabilitation.

There was moderate quality evidence that people who experienced a shorter duration of illness before rehabilitation, and who had lower psychopathology scores, were more likely to progress through the rehabilitation pathway to greater independence. However, the committee thought that everyone with treatment-resistant symptoms and functional impairments had the potential to benefit from rehabilitation, and that this applied regardless of whether they were living in inpatient or community settings.

The committee also highlighted the groups of people who, in their experience, are likely to have treatment-resistant symptoms and functional impairments.

The committee was aware that some people leaving early intervention services have significant residual disability, with persisting symptoms and functional impairment. However, it was not possible from the evidence to determine whether providing very early access to rehabilitation to these people could prevent repeated admissions and problems in daily living. The committee therefore made a research recommendation on who should be offered rehabilitation.

How the recommendation might affect practice

Earlier access to rehabilitation should deliver more effective treatment sooner. This should reduce repeated admissions, enable earlier referral to less intensive (and cheaper) services and support more independent living. There may be some resource impact if more units are needed; however, most trusts in England have existing mental health rehabilitation units and half of trusts have community mental health rehabilitation teams who work with people after they have left hospital and moved to supported accommodation. In areas without these teams, community mental health teams already coordinate care. There will also be substantial savings from the repatriation of people placed out of area.

Source guidance details

Comes from guidance

Rehabilitation for adults with complex psychosis

Number

NG181

Date issued

August 2020

Other details