Early Intervention for Psychosis
Why is early intervention for psychosis important?
- Psychosis affects 3 in every 100.
- The average length of untreated first episode in psychosis in Dublin is 2 years (DETECT, 2010).
- Longer duration of untreated psychosis increases the likelihood of suicide.
- Longer duration of untreated psychosis reduces the likelihood of a full recovery.
- Early detection and effective treatment are associated with substantially improved outcomes.
International development of early intervention teams for psychosis and schizophrenia
The development of early detection and intervention teams for psychosis and schizophrenia has been one of the major movements in psychiatry in the past two decades. This follows on from evidence that longer duration of untreated psychosis (DUP) is associated with a worse prognosis (Perkins et al., 2005, Marshall et al., 2005, Lappin et al., 2006, Harvey et al., 2008, Clarke et al., 2006b, Clarke et al., 2006a).
International examples include:
- Early Psychosis Prevention and Intervention Centre (EPPIC) in Australia (http://eppic.org.au/)
- Detect in Dublin South (http://www.detect.ie)
- Early Intervention in Psychosis (http://www.iris-initiative.org.uk/)
- The TIPS program in Norway (http://www.tips-info.com/)
- The Prevention and Early Intervention Program for Psychoses(PEPP) in Canada (http://www.pepp.ca/)
Typically the focus of these teams is assertive detection of cases at the earliest stage of the illness, either during the first episode of psychosis, or, in the case of some teams, the prodromal phase, in those who are considered to be at “Ultra High Risk” (UHR) of developing schizophrenia or psychosis (Yung and Nelson, 2011).
- PERKINS, D. O., GU, H., BOTEVA, K. & LIEBERMAN, J. A. 2005. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. The American journal of psychiatry, 162, 1785-804.
- MARSHALL, M., LEWIS, S., LOCKWOOD, A., DRAKE, R., JONES, P. & CROUDACE, T. 2005. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of general psychiatry, 62, 975-83.
- LAPPIN, J. M., MORGAN, K., MORGAN, C., HUTCHISON, G., CHITNIS, X., SUCKLING, J., FEARON, P., MCGUIRE, P. K., JONES, P. B., LEFF, J., MURRAY, R. M. & DAZZAN, P. 2006. Gray matter abnormalities associated with duration of untreated psychosis. Schizophrenia research, 83, 145-53.
- HARVEY, S. B., DEAN, K., MORGAN, C., WALSH, E., DEMJAHA, A., DAZZAN, P., MORGAN, K., LLOYD, T., FEARON, P., JONES, P. B. & MURRAY, R. M. 2008. Self-harm in first-episode psychosis. The British journal of psychiatry : the journal of mental science, 192, 178-84.
- CLARKE, M., WHITTY, P., BROWNE, S., MC TIGUE, O., KINSELLA, A., WADDINGTON, J. L., LARKIN, C. & O'CALLAGHAN, E. 2006a. Suicidality in first episode psychosis. Schizophrenia research, 86, 221-5.
- CLARKE, M., WHITTY, P., BROWNE, S., MCTIGUE, O., KAMALI, M., GERVIN, M., KINSELLA, A., WADDINGTON, J. L., LARKIN, C. & O'CALLAGHAN, E. 2006b. Untreated illness and outcome of psychosis. The British journal of psychiatry : the journal of mental science, 189, 235-40.
- YUNG, A. R. & NELSON, B. 2011. Young people at ultra high risk for psychosis: a research update. Early intervention in psychiatry, 5 Suppl 1, 52-7.
National Clinical Care Programme for Early Intervention in Psychosis (NCP-EI)
- The development of the National Clinical Programmes is an innovation by the Health Service Executive (HSE) to introduce standardised, effective, health interventions nationwide (Quality and Clinical Care Directorate, 2011).
The Clinical Programme for Mental Health is seeking to implement the National policy document “A Vision for Change”, through;
- The management of mental health disorders within an evidence based framework of service provision.
- The adoption of an early intervention approach and of more assertive and effective illness intervention/prevention strategies at primary care level.
- The development of partnerships with primary care, voluntary and community agencies.
- The promotion of positive outcomes/recovery for those with mental illness, including the improvement of social functioning and the promotion of personal autonomy and well-being.
Key Solution Areas:
During year one Community Mental Health Teams and GPs will develop.
1. An Early Intervention Programme for First Episode Psychosis.
2. An Early Intervention Programme for Eating Disorders.
3. A programme for the management of Self Harm among Service Users presenting to Hospital Emergency Departments.
This will result in:
- Screening and early identification of people at risk by GPs.
- Rapid access to and assessment by Community Mental Health Teams within set time targets.
- Standardisation of treatment options for service users across the country based on best available evidence.
- Development of shared care arrangements between GPs and specialised Mental Health Services.
- Working in partnership with agencies within the community to provide assertive follow up.
- A focus on positive outcomes for service users and a recovery approach to service delivery.
For further details go to www.hse.ie/mentalhealthprogramme/