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National Psychosis Service - Inpatients

How our service can help you

The National Psychosis Service (NPS) is a clinical-academic tertiary service offering innovative individualised evidence-based multidisciplinary strategies to help those people with complex psychosis, including schizo-affective disorder, where standard treatment guidelines have proven ineffective or have not been tolerated. The service aims to enhance quality of life through tailored treatments and promotion of recovery thus reducing the need for high intensity placements and the risk of readmission.

Internationally renowned expertise in resistant psychosis is provided by a team of dedicated clinicians offering comprehensive medical reviews alongside innovative, bespoke treatment approaches. Themes include complex co-morbid physical health conditions which directly affect psychiatric treatment options; clozapine re-challenge after a significant adverse reaction; clozapine non-response.

Our specialist service is supported through established partnerships with the academic Departments of Psychosis Studies and Psychology based within the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. We also liaise with clinical experts within other specialties across King’s College London and King’s Health Partners. The National Psychosis team is closely linked to the Maudsley Pharmacy and the other national specialist mental health services.

The service aims to enhance quality of life through collaborative working towards recovery. We regularly audit and publish our service outcomes and receive excellent feedback from our patients and their families. Benefits include reduction in psychosis, less frequent episodes of illness, improved social functioning, better understanding of the illness by the patient and carers and enhanced engagement with physical and mental health care plans. We have published evidence that admissions result in reduced morbidity, fewer days spent in hospital, lower antipsychotic doses, substantial reductions in the risk of readmission or high intensity placements and less expensive long-term costs.

As our patients may be a long way from home, we aim to make admissions as short as possible and communicate regularly with carers, the referring team and CCGs or CSUs to plan care and facilitate timely discharge.

**The National Psychosis Unit will no longer be overseen by the Croydon and BDP directorate as of July 3, 2023. The PMOA Directorate will oversee the clinical and operational management of the unit**

  • Treatment type: Inpatient
  • Contact the service

    Site Location: Bethlem Royal Hospital Email: Phone Number: 020 3228 4322 or 020 3228 4276
  • Disabled Access: Service is located on first floor
  • Address: Bethlem Royal Hospital
    First Floor,
    Fitzmay 2
    Fitzmary House
    Monks Orchard Road,
    BR3 3BX
  • Business Hours/Visiting Hours:

    Outpatient: 9am – 5pm

    Visiting times: 10am-8pm

  • Other essential information

  • Conditions: schizo-affective disorder, schizoaffective disorder, Addictions, Anxiety, Attention deficit hyperactivity disorder (ADHD), Autism, Bipolar disorder, Body dysmorphic disorder (BDD), Childhood degenerative disorders, Dementia, Depression, Dissociative disorders, Eating disorders, Learning disabilities, Neuropsychiatry, Obsessive compulsive disorder (OCD), Perinatal disorders, Persistent physical symptoms, Personality disorders, Post-traumatic stress disorder (PTSD), Psychosexual, Psychosis, Self-harm


  • Psychosocial interventions implemented by a team with collective expert knowledge of complex and difficult to treat psychosis with an in-depth, specialist understanding of the treatment challenges and workable solutions to meet the needs of this client group
  • Liaison with physical health partners for enhanced management of complex physical health conditions and co-morbidities
  • Comprehensive pharmacological review of recorded treatments and side effects
  • Innovative and bespoke pharmacological treatments
  • Clozapine re-challenge after major complications or difficulty in initiation
  • Consistent delivery of bespoke nursing care plans
  • Therapeutic groups for health promotion and well-being interventions
  • Evidence-based cognitive behavioural therapy (CBT) and family therapy
  • Low intensity psychological interventions in individual and group formats, for example, coping with unusual experiences, improving sleep, problem-solving, mindfulness
  • Proactive and accessible support for carers
  • Suitable for nursing in an open and mixed gender environment at the time of transfer
  • Individual carer support including psycho-education
  • Monthly carer groups for relatives of current and discharged service users
  • Expert pharmacy medication review and side-effects monitoring
  • Comprehensive assessment, treatment and recommendations for future placement with robust discharge planning and co-ordination in partnership with local services
  • Intensive occupational therapy programme, both individual and group
  • Specialist social and vocational interventions
  • Art therapies – music, art and drama therapy
  • Holistic therapy interventions including movement, dance, yoga and relaxation
  • Assessment and management of cognitive deficits
  • Pharmacogenetic assessment where indicated
  • Support with managing financial needs
  • Capacity and Care Act needs assessments
  • Joint working, where appropriate, with other national services such as the National Affective Disorders Service and the National Autism Service

Eligibility criteria

  • 18 years and older
  • Male or female
  • Experience of persistent or recurring psychotic symptoms or mania despite treatment along recognised pathways, or requires further inpatient assessment of probable psychotic symptoms
  • Typical diagnostic categories include psychosis, schizophrenia, bipolar disorder, refractory mania, schizoaffective disorder, delusional disorder and drug induced psychosis, as well as co-morbid conditions
  • Undetermined diagnoses of psychosis
  • Poor response to pharmacological treatments including difficulties with tolerance
  • Complications with clozapine use or initiation
  • Co-morbid medical or mental health conditions complicating treatment approaches
  • Where an evidence-based psychological treatment for psychosis is required (for example cognitive behaviour therapy, family therapy)
  • Mild intellectual disability, joint working with the person’s local intellectual difficulties services
  • Informal status and those detained under section of the Mental Health Act
  • Suitable for nursing in an open and mixed gender environment
  • Active engagement and support provided by local community mental health team (CMHT) and care co-ordinator


Our published outcomes are world class, demonstrating clinical excellence:

  • Reduction in psychosis
  • Improved quality of life
  • Reduced overall care costs
  • Expanded discharge destination options
  • Less frequent episodes of illness
  • Improved social functioning
  • Improved engagement with treatment plans
  • Improved understanding of illness by the patient and carers
  • Better physical healthcare leading to reduced morbidity
  • Fewer mental health admissions and bed days
  • Fewer in-patient days in physical health hospitals
  • Reduction in the total number of in-patient days
  • Reduction in level of support required

Read more in these research articles:

Krivoy et al, 2019
Sarkar et al, 2014 
Tracy et al, 2015 
Casetta et al, 2020

While almost all out inpatients come from acute inpatient or PICU settings, they are predominantly discharged to the community or to rehabilitation settings (Casetta et al 2020, in press: real-world-effectiveness-of-admissions-study.pdf).

Care Options


Care option:  Psychosis – IP Assess & Treat (IP)
Code: 13540

Please contact our administration team to enquire about other care options.

Our experts

Our experts include some of the most highly cited in our field worldwide. Our focus on treatment resistant psychosis over three decades has enabled us to become a world class centre of excellence in this field. For instance, our research group on the antipsychotic drug clozapine is the most highly cited worldwide.

Prof Fiona Gaughran: Read more

Prof James MacCabe: Read more

Prof Sir Robin Murray: Read more

Prof David Taylor: Read more

Eromona Whiskey: Read more

Dr Maria Antonietta Nettis: Read more


Our clinicians offer education and training in the assessment and management of difficult to treat psychosis. This is available for individuals or small groups of professionals or may be extended as an outreach package for team-based training of larger groups. In addition, for those wishing to develop refractory psychosis services, consultations are provided to clinicians, managers and commissioners. The programme delivers the following outcomes:

  • Develops an understanding of the theoretical principles that underpin the effective assessment and management of resistant psychosis
  • Increases clinicians’ competence and confidence in the assessment and management of resistant psychosis
  • Explores ways in which psychopharmacological and psychotherapeutic skills can be combined with knowledge of emerging treatment strategies in resistant psychosis, including how to optimise clozapine treatment and reduce the medical risk associated with persistent psychosis 
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