Early intervention services for psychosis

Research led by Professors Tom Craig, Philippa Garety & Philip McGuire

Our researchers helped prove the efficacy and cost-effectiveness of early intervention services for psychosis, which have now been widely developed across England.

Early intervention services that support people who are experiencing the symptoms of psychosis for the first time are now available all over England. But these specialist services have not always been commonplace. Our researchers helped prove their efficacy, demonstrated their cost-effectiveness, and were instrumental in setting the original Government policy that enabled their widespread development.

Early intervention services aim to give young people and their families comprehensive help, treatment and support when they first become unwell and during the following few years – including information about cognitive behaviour therapy, family therapy and medication.

The pioneering Lambeth Early Onset Team (LEO) was one of the first services of its kind. It was launched in 2000 as part of a research project to assess a specialist service geared towards supporting young people experiencing their first episode of psychosis. LEO was open for extended hours, seven days a week, and aimed to meet all the needs of its clients and their families under one roof. The support on offer was specially adapted for young people and the team also advised about accommodation, benefits, employment and education.

The results of the LEO randomised controlled trial, led by Professor Tom Craig showed that young people referred to LEO had a better prognosis than those treated by their local community mental health team (CMHT). After 18 months, people referred to LEO were more likely to have returned to work or study than those who were offered conventional support from a CMHT.

People supported by LEO were also more likely to have maintained or rebuilt good relationships with their families and friends, and more likely to be taking medication regularly. They were less likely to be in hospital and more likely to be in contact with mental health professionals. An analysis by Professor Paul McCrone and colleagues at our Centre for the Economics of Mental and Physical Health showed that the overall costs of LEO was lower than the costs of standard CMHT care, mainly as a result of fewer admissions to hospital.

The LEO trial added to mounting evidence that early intervention for psychosis works. At the end of the trial, LEO became a mainstream service run by the South London and Maudsley NHS Foundation Trust.

The creation of LEO followed a Government commitment to set up early intervention for psychosis services, first made in 1999 – a reflection of the campaign from charities and other voluntary organisations for better services for young people experiencing the symptoms of psychosis.

In 1999, there were two early intervention teams in England, caring for about 80 young people. Between July and September 2012, more than 21,000 people were treated by early intervention teams operating throughout the country.

Early intervention teams are usually made up of a range of professionals, including psychiatrists, psychologists, mental health nurses and social workers. Some also include vocational workers or employment specialists.

The LEO trial is cited in the 2009 NICE guideline on schizophrenia, which recommends early intervention services be offered to any person who is experiencing a first episode of psychosis.

References

• Early Psychosis Declaration. An International Consensus Statement about Early Intervention and Recovery for Young People with Early Psychosis. Jointly issued by the World Health Organisation and International Early Psychosis Association, 2004
• Craig TK et al. The Lambeth Early Onset (LEO) team: randomised controlled trial of the effectiveness of specialised care for early psychosis. BMJ, 2004; 6: 329(7474): 1067
• Broome ME et al. Outreach and Support in South London (OASIS): implementation of a clinical service for prodromal psychosis and the at risk mental state. European Psychiatry, 2005; 20(5-6): 372-378
• Garety PA et al. Specialised care for early psychosis: symptoms, social functioning and patient satisfaction: randomised controlled trial. British Journal of Psychiatry, 2006; 188: 37-45
• McCrone P et al. Economic impact of services for first-episode psychosis: a decision model approach. Early Intervention in Psychiatry, 2009; 3(4): 266-73
• Gafoor R et al. Effect of early intervention on 5-year outcome in non-affective psychosis. British Journal of Psychiatry, 2010; 196(5): 372-6
• McCrone P et al. Cost-effectiveness of an early intervention service for people with psychosis. British Journal of Psychiatry, 2010 May; 196(5): 377-82