Global update on Early Intervention Services for psychosis

What do politicians want to know to inform their allocation of resources for early intervention services for psychosis, which outcomes should be measured for individuals at ultra-high-risk of psychosis, and how can early intervention service principles be applied in low- and middle-income countries? Experts shared their experiences in addressing these questions in a thought-provoking presidential symposium at WPA 2021.

What do politicians want to know about EIS?

It may take several years to implement early intervention services and embed them into the healthcare system

Specialist early intervention services (EIS) for psychosis shorten the duration of untreated psychosis (DUP) and improve outcomes (read more here). They are available in many high-income countries and are embedded within the publicly funded national health systems of the United Kingdom, Norway, Denmark and Singapore, and since 2020, in Greece.

Professor Nikos Stefanis of University of Athens explained it had taken many years of political lobbying with talks involving stakeholders and national support networks.1,2

He highlighted that the politicians wanted to see cost-effective evidence and hear personal narratives.

 

Which outcomes should be measured for UHR individuals?

Ultra-High Risk individuals who do not develop psychosis experience poor social functioning

The risk of developing psychosis for individuals at ultra-high-risk (UHR) of psychosis is 22% after 1 year, 29% after 2 years, and 36% after 3 years,3 said Professor Alison Yung of University of Melbourne, Australia.

Furthermore, UHR individuals who do not develop psychosis experience subthreshold symptoms and poor social functioning. However, UHR individuals often delay seeking mental health support for over 1 year.4

We need to improve the ability to identify UHR individuals and ensure they can access care, Professor Yung said.

A variety of strategies to screen for UHR individuals and provide needs-based care have been set up in a number of countries. Most recently, a Norwegian initiative based on a public health campaign and a targeted education program for people in contact with young people led to the detection of 1857 individuals with psychotic-like symptoms.5

Ultra-High Risk individuals often delay seeking mental health support for over 1 year

Professor Yung highlighted the heterogeneity of UHR individuals and gaps in current knowledge. In particular, it is not clear how UHR individuals should be treated or which outcomes or markers for these outcomes should be measured. Many outcomes and markers for these outcomes need to be assessed to enable treatment trials and personalized interventions, she concluded.

 

How can EIS principles be applied in low- and middle-income countries (LMIC)?

Approximately 80% of people with mental disorders including most patients with first‐episode psychosis live in LMIC and have little or no access to healthcare,6 said Professor Swaran Preet Singh, University of Warwick, UK.

80% of people with mental disorders have little or no access to healthcare

In 2008, the average mean DUP in LMIC was 125 weeks compared with 63.4 weeks in high-income countries. Mean DUP decreases by 6 weeks for every $1000 increase in GDP.7

Traditional healers are often the initial contact for patients, and consulting a healer is associated with a longer DUP.8

A lack of financial and manpower resources in LMIC mean it is not feasible to translocate Western models of EIS, said Professor Singh, but EIS principles can guide the development of EIS in LMIC.9 For example, the Warwick-India-Canada (WIC) Network is developing an EIS for India using a strengths-based protocol-driven approach that takes into account cultural contexts and leverages the widespread use of mobile phones.

 

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Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. Kollias K, et al. Psychiatriki 2020, 31:177–182.
  2. Stefanis NC, et al. Psychiatriki 2018;29:107–17.
  3. Fusar-Poli P, et al. Arch Gen Psych 2012;69:220–9.
  4. Fusar-Poli P, et al. JAMA Psych 2020;77:755–65.
  5. Joa I, et al. Front. Psychiatry 2021;12:573905.
  6. Rathod S, et al. Health Services Insights 2017;10:1–7.
  7. Large M, et al. BJPsych 2008;193:272–8.
  8. Lilford P, et al. Asian J Psych 2020;54:102237.
  9. Singh SP, Javed A. World Psych 2020;19:122.
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