Early intervention in psychosis: obstacles and opportunities

Abstract

By focusing therapeutic effort on the early stages of psychotic disorders, effective early intervention should improve short- and long-term outcomes. Strategies include pre-psychotic and prodromal interventions to prevent emergence of psychosis, detecting untreated cases in the community and facilitating recovery in established cases of psychosis. The evidence base for each of these strategies is currently limited, although several international trials are under way. The Department of Health in the UK has announced the intention of setting up 50 early intervention services nationally, several of which are already operational. In this article, we briefly discuss the differing ways in which early intervention is conceptualised, summarise the evidence supporting it in established cases of psychosis, suggest appropriate service models and describe two early intervention services in south-west London.

Recording of Severe Mental Illness in United Kingdom Primary Care, 2000–2010

“…We examined two subgroups according to age criteria: those traditionally eligible for entry to Early Intervention Services in the UK (16 to 35 years old)[26], [27] those eligible for entry to General Adult psychiatric services (16 to 65 years old).…”

The Individual Placement and Support approach to vocational rehabilitation for young people with first episode psychosis in the UK

“…The team is multi-disciplinary in approach and provides a comprehensive package of community-based care for a maximum of 2 years to young people with a first episode of psychosis. For more details see Singh and Fisher (2005).…”

A first step in system improvement: a survey of Early Psychosis Intervention Programmes in Ontario

“…A stand‐alone specialist team with trained staff and small caseloads is advocated as the gold standard to deliver the model, but is not always feasible to implement. Alternative approaches embed EPI delivery within general mental health teams, supported by strategies such as whole team education, training of selected team staff as EPI specialists, providing protocols for identifying and managing first‐episode clients, supervision by EPI specialists, protecting staff time for EPI delivery and establishing area early intervention networks . Studies have shown that alternative models can deliver the complement of services that constitute EPI, with positive results …”