The UK’s first Baseline Biomarker Check (BBC) clinic has been launched in Oxford, designed to improve the assessment of people experiencing first-episode psychosis.
First-episode psychosis is the term used when a person experiences psychosis for the first time. People experiencing psychosis may see or hear things that others do not, known as hallucinations, or develop unusual beliefs that can be difficult to change, known as delusions.
Experiencing psychosis can be distressing and confusing for individuals and their families. Symptoms often first develop during late adolescence or early adulthood, although people can be affected at any age.
Early assessment and treatment can significantly improve outcomes. However, psychosis can have many different causes, and there is considerable variation in how people respond to treatment. In routine clinical practice, it can therefore take time to establish the most appropriate diagnosis and treatment for an individual.
The new BBC clinic has been developed to address these challenges by providing a more comprehensive and standardised assessment early in a person’s care. Its development has been informed by pilot work and feedback from people with lived experience of psychosis, helping to shape the clinic around the needs and experiences of people using the service.
Based at Oxford Health NHS Foundation Trust’s Warneford Hospital site, the clinic is supported by funding from NIHR Biomedical Research Centre (BRC): Oxford Health and Wellcome.
The BBC clinic provides a one-off enhanced clinical assessment for people receiving care through Oxford Health’s Early Intervention in Psychosis service. It brings together clinical interview, brain imaging, thinking and memory assessment, and neurological health checks, within a single clinic appointment to provide a more complete picture early in a person’s care.
Alongside improving clinical care, the clinic provides patients with the opportunity to participate in research aimed at understanding why psychosis develops and why people respond differently to treatment.
By embedding research within routine NHS care, the longer-term aim is to develop more personalised approaches in which assessment and treatment can increasingly be tailored to the individual.
The clinic is believed to be the first service of its kind in the UK.
What is offered at the BBC clinic:
During a single clinic visit, patients are offered:
- An MRI brain scan
- Memory and thinking assessments
- A physical health examination, including assessing neurological health
- A detailed discussion about their symptoms, health, background and experiences.
For patients, this means more detailed assessment in a single visit, as well as shorter waits for appointments and test results.
For clinicians, the clinic offers access to a richer set of information that can support personalised care and treatment planning.
Research opportunities at the BBC Clinic:
A unique feature of the BBC clinic is its integration of research opportunities within routine NHS care.
Patients who attend the clinic can choose whether they would like to take part in additional research activities. Participation is entirely voluntary and separate from their clinical care.
Optional research activities may include:
- Advanced research-grade MRI brain imaging
- Additional memory and thinking assessments delivered via an iPad
- Providing biological samples, such as a blood sample
Researchers hope that the information gathered through the clinic will improve understanding of psychosis and contribute to the development of better ways to diagnose and treat the condition in future.
The clinic will also create a valuable resource for mental health research by enabling research data to be linked with detailed clinical information from a representative patient population.
Katie, an Oxfordshire resident who has experienced psychosis, went through the clinic process as part of a pilot. She said:
“The experience of trial-running the clinic was very informative, I learned a lot about the research process and what all aspects of the patient visit would be like.
“I was made to feel very welcome by the research team. The BBC Clinic felt like a safe space to talk, I felt listened to and I was well guided throughout the different parts of the clinical assessments and optional research opportunities.
“I feel that in taking part in this aspect of study design, that I can be part of a change that provides more options for people living with psychosis in the future.”
Improving care now and in the future
The BBC clinic forms part of a wider vision to improve outcomes for people experiencing psychosis.
As well as benefiting patients currently receiving care, the service will generate evidence that could help shape future NHS services across the UK.
Oxford Health NHS Foundation Trust hopes that sharing the clinic’s learning, results and research outputs will support collaboration with clinicians, researchers, NHS organisations and national partners interested in developing similar approaches.
The initiative could also help build the case for future investment in specialist psychosis services and wider implementation of enhanced assessment pathways.
Dr Graham Blackman, Consultant Psychiatrist at Oxford Health NHS Foundation Trust, Senior Clinical Researcher in the University of Oxford’s Department of Psychiatry and BBC clinic lead, said:
“Experiencing psychosis for the first time can be overwhelming for patients and their families.
“The new BBC clinic allows us to bring together a range of assessments in one place and at an early stage in a person’s care.
“By gaining a more complete understanding of each individual’s health and experiences, we hope to improve diagnosis, support more personalised treatment and ultimately achieve better outcomes for people affected by psychosis.”
Dr Blackman is also a researcher in the NIHR BRC: Oxford Health. His clinical work focuses on the assessment and treatment of severe mental illness, including first episode psychosis.
To get in touch with a researcher, email [email protected] or call: 01865 613115.
