This theme focused on improving the help-seeking and care pathways of young people with first-episode psychosis. An integral part of the research was a public health initiative targeting the key pathways in Birmingham responsible for delays in the treatment of psychosis, with the overall aim of dramatically reducing the duration of untreated psychosis (DUP) experienced by young people in Birmingham.

We know from examining literature that education and contact are some of the most effective approaches for challenging stigma and reducing related barriers to help-seeking for mental health difficulties. The team integrated these approaches into their public health work, aiming to improve mental health literacy and awareness of early signs and symptoms, as well as promoting appropriate interaction (through live contact, films, videos, blogs and case stories) with individuals who have experienced mental health difficulties.

Some examples of how we integrated service user contact and mental health literacy in our public health work to support the theme aims include:

• Our YouthBoard, which has involved over 65 service-users and members
• Our website, designed by our YouthBoard to offer relevant, up-to-date information and advice on all aspects of mental health, resilience and emotional wellbeing
• The ‘Don’t Turn Your Back on the Symptoms of Psychosis’ public health campaign
• Our information phone line which is dedicated to helping anyone who wants to know more about psychosis (0121 301 4332)
• The Schoolspace programme, which has involved randomised controlled trials, interventions, workshops and surveys
• The Mind Out event at the Midlands Arts Centre in March 2012
• Our partnership with The Prince’s Trust
• Youth Mental Health Training Workshops for professionals working with young people
• Regular interactive information stands and presentations at community events
• Maintaining links with employment services, housing services, drugs and alcohol teams, emergency services, youth clubs, community centres, social services, religious centres, colleges and universities

Our projects

Youthspace

The overarching aim of Youthspace is to reduce delay in accessing appropriate mental health treatment at the earliest opportunity for young people through targeted, indicated and universal (preventative) approaches. To achieve this, the Youthspace multifaceted public health intervention has been implemented.

The Youthspace approach integrates research, clinical practice, user involvement and public mental health into a responsive preventative strategy for young people and their families. Key components of the strategy include:

• Development and on-going support of an active and influential ‘YouthBoard’ of young service users, carers and volunteers to advise and direct all elements of our work
• Work with primary care, Child and Adolescent Mental Health Services (CAMHS) and YouthBoard to create an effective and appropriate youth clinical service to meet local needs, reduce delays, improve transitions between services and adopt a preventative triaged intervention model
• An educational randomised controlled trial in secondary schools across Birmingham involving service users in applying ‘contact’ to reduce stigma and increase mental health literacy in young people
• Effective working partnerships with Birmingham CAMHS, The Prince’s Trust and other third sector organisations
• An iterative evaluation and knowledge transfer model employing evidence-based research through our CLAHRC involvement
• Use of Health Behaviour Change and Public Health Planning models throughout
• Monitoring of care pathways of young people experiencing psychosis in the south of Birmingham

Some of our ongoing, high-impact research has been covered in the national press and The Guardian has reported on some of our work around using drugs to treat people at risk of psychosis. This shows the importance of our clinical youth mental health service approach in south Birmingham which has been informed by Youthboard members’ feedback and involvement in clinical trials of international importance.

YouthBoard

Our YouthBoard has involved service users and carers in a range of projects including advising on the recent service redesign work that has resulted in the new clinical youth team operating in south Birmingham.

The YouthBoard was also involved in the creation of campaign materials including for the general ‘Don’t Stay Silent’ campaign promoting the website www.youthspace.me and the ‘Don’t turn your back on the symptoms of psychosis’ campaign that was launched in January 2012 in south Birmingham. Posters were displayed throughout the city and sent to over 500 health, youth and community locations with more added all the time. Some of the posters can be seen at www.flickr.com/photos/y0uthspace/

‘Youth Board Yells!’ is the YouthBoard’s quarterly newsletter, which describes current projects and the variety of work it is involved in. The first issue can be downloaded from
www.bvsc.org/sites/default/files/files/YBY_Issue%201_1112.pdf

Youthspace website

The Youthspace website, www.youthspace.me has been driven by service users, who were involved throughout its design. It has one of the most complete and up-to-date sets of educational resources available online for common mental health disorders. There are additional educational films, including dramas and real-life stories created for the site linked through Vimeo and YouTube, with Facebook and Twitter links. The Youthspace website hosts a blog that includes information sent from contacts at schools and universities alongside information on treatments and self help. There are almost 100 downloadable tools and information booklets/factsheets available to download on the site and it is currently being updated to have more interactive elements and training tools.

Schoolspace

Our ‘Schoolspace’ programme has involved a randomised controlled trial in 11 schools, a teachers intervention involving five schools and several workshops and surveys. Over 3,000 students and teachers have taken part. The trial has involved service users as co-facilitators of a full day of educational interventions. Download the trial protocol.

‘Mind Your Head’ Drama Event

The Mind Your Head event, which took place at the Midlands Arts Centre in March 2012, was a collaboration between CLAHRC-BBC, the Birmingham Repertory Theatre and the Hearth Theatre Company. It was a full day of two plays, four workshops and discussions on the themes of self-harm and stress and mental ill-health.

Partnership with The Prince’s Trust

Our partnership with The Prince’s Trust is enabling us to increase our impact and range in training and we have several staff trained in mental health first aid. We have also developed an e-learning tool that will be used to train staff working with young people to identify subtle mental health difficulties in youth. It was created, filmed and pulled together by service users from our YouthBoard.

Psychosis campaign

Research suggests that a detailed understanding of the care pathways within both mental health service settings and the community are required to reduce the duration of untreated psychosis. Complementing the service redesign, the ‘Don’t Turn Your Back on the Symptoms of Psychosis’ public health campaign aims to raise awareness of the symptoms of psychosis, the benefits of seeking help early and how to get help. To achieve the aim of reducing the duration of untreated psychosis experienced by young people (aged 14-35 years) following the onset of a first episode, the campaign has included:

• Strong links with youth and community workers, employment services, housing services, drugs and alcohol teams, emergency services, colleges and universities.
• Bus and street advertising.
• Mail drops in the south of Birmingham.
• Posters and ‘give-aways’.
• Interactive information stands and presentations at community events.
• Regular spots in community press and on community websites.
• Direct link to the psychosis page on the Youthspace website.
• Information line (0121 301 5858).
• Youth Mental Health Training for professionals working with young people in the intervention area.
• Input and feedback from the YouthBoard.
• Regular evaluation and feedback forms filled in by the public and our professional partners.
• Individualised materials, providing a targeted approach to either young people and/or their carers and family.
• Information about the campaign can be found at http://www.youthspace.me/blog/Blog.aspx?id=187, along with downloadable materials to help with identification and understanding of psychotic disorders.

Information Line

We have launched an information phone line which is dedicated to helping anyone who wants to know more about psychosis. The information line is manned by trained staff who provide up-to-date and age-appropriate information on psychosis and where to get help. The telephone number is on our flyers and posters, and is being advertised on bus posters around Birmingham. Press releases about the information line accompanied by a promotional bus photo are being published in local magazines and newspapers.

Mental health first aid training

We worked with youth mental health teams at Birmingham and Solihull Mental Health Foundation Trust to deliver mental health first aid (MHFA) training across local settings, aimed at staff working with young people.

Publications

Author(s)	Title	Journal or Conference	Publication date
Barrett, B; Waquas, W; Simone, F; Birchwood, M; Dunn, G; Flach,C; Henderson,C; Leese, M; Lester, H; Marshall, M; Rose, D; Sutherby, K; Szmukler, G; Thornicroft, G; Byford, S	Randomised controlled trial of joint crisis plans to reduce compulsory treatment for people with psychosis: economic outcomes	PLoS One doi: 10.1371/journal.pone.0074210	25 November 2013
Ackner, A; Skeate, A; Patterson, P; & Neal, A	Emotional Abuse and psychosis: A Recent Review of the Literature	Journal of Aggression, Maltreatment & Trauma, Volume 22, Issue 9, 2013 doi:10.1080/10926771.2013.837132	1 November 2013
Winsper, C; Singh, SP; Marwaha, S; Amos, T; Lester. H; Everard, L; Jones, P; Fowler, D; Marshall, M; Lewis, S; Sharma, V; Freemantle, N; Birchwood M	Pathways to violent behavior during First-Episode Psychosis: A report from the UK National EDEN study	JAMA Psychiatry 2013 doi: 10.1001/jamapsychiatry.2013.2445.	2 October 2013
Scott, J; Fowler, D; McGorry, P; Birchwood, M; Killackey, E; Christensen, H; Glozier, N; Yung, A; Power, P; Nordentoft, M; Singh, S; Brietzke, E; Davidson, S; Conus, P; Bellivier, F; Delorme, R; Macmillan, I; Buchanan, J; Colom, F; Vieta, E; Bauer, M; McGuire, P; Merikangas, K; Hickie, I	Adolescents and young adults who are not in employment, education, or training. Their problems are more than economic (Editorial)	BMJ 2013;237:f5270 doi: 10.1136/bmj.f5270	18 September 2013
Farrelly, S; Szmukler, G; Henderson, C; Birchwood, M; Marshall, M; Waheed, W; Finnecy, C; Thornicroft, G	Individualisation in crisis planning for people with psychotic disorders	Epidemiology and Psychiatric Sciences doi: http://dx.doi.org/10.1017/S2045796013000401	10 September 2013

Theme lead

Professor Max Birchwood

Partners

• Birmingham and Solihull Mental Health NHS Foundation Trust
• University of Birmingham