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SPECIAL ARTICLES: J. BERTOLOTE and P. McGORRY Early intervention and recovery for young people with early psychosis: consensus statement The British Journal of Psychiatry 2005; 187: s116-119s [Abstract] [Full text] [PDF]

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Implementing Early Intervention In The UK

Mark Agius   (10 August 2005)

Implementing Early Intervention In The UK 10 August 2005
Mark Agius, Associate Specialist Luton Early Intervention Team Send letter to journal: Re: Implementing Early Intervention In The UK mark.aguis{at}blpt.nhs.uk Mark Agius	Dear Sir, The WHO/IEPA consensus statement on Early Intervention in Psychosis [Bertolote 2005] is extremely timely. Besides setting international good practice standards for the appropriate treatment of young people with psychotic illness, it clarifies that prompt and effective interventions for young people with early psychosis, and their families and carers represents a major element of respect of individual’s rights to citizenship and social inclusion. This emphasis on the appropriate treatment of patients as a matter of Human Rights is echoed in the recent WHO Declaration on Mental Health in Europe. [WHO 2004], and it gives patient organisations an important position of strength in negotiating with National and Local Government regarding the needs of their clients. A consensus evidence based review on Community Psychiatry in Europe has recently been published [Agius 2005], and Early Intervention in Psychosis is discussed as one of the key standards which should be met by Community Psychiatry Services. It is expected that this review will form the basis of a declaration of the rights of Mental Health Patients in Europe which is to be adopted by Gamian- Europe [the umbrella organisation for patient advocacy groups in Europe] at its Convention in Bucharest in September. In the UK, however, while much progress has been made in the development of Early Intervention Teams, much still needs to be done. It is true that ‘there is ambivalence and resistance to this evidence based reform’. [McGorry 2005]. The implementation of Early Intervention has had to be done in the face of the doubts of many clinical colleagues who have doubted the evidence. More importantly, Government Money allocated to Early Intervention has often failed to materialise at a clinical level, since middle management, particularly commissioners in Primary Care Trusts, have all too often felt free to divert Mental Health Resources to other priorities which have been viewed as being more pressing, or even to ‘Achieve Financial Balance’. One cannot help commenting that this must constitute a form of stigmatisation of Mentally Ill Patients at a high level, by managers who should know better. As a consequence, the development of Early Intervention Services has been delayed in many places, and in one case, a well established Early Intervention Team has been threatened with closure by its local PCT. How then can the Royal College of Psychiatrists help in the present situation? At the Faculty of General and Community Psychiatry meeting in Liverpool in October, the establishment of a Royal College Special Interest Group for Early Intervention will be suggested, in order to enable the doctors who work in Early Intervention to adopt common standards and act with one voice. It is suggested that the International Clinical Practice Guidelines for Early Psychosis [IEPA 2005] should be adopted as College Clinical Guidelines, of the same standing as the RCPsych Clinical Guidelines on ECT, and implemented across the country in a form which is appropriate to the UK situation. Since Early Intervention , as well as Crisis Intervention and Assertive Outreach are the types of teams which will deliver Community Psychiatry in the future, It is suggested that it should become Royal College Policy not to approve training schemes in the future which cannot demonstrate the presence of SHO training posts in these three specialist areas. Finally, Government can no longer delay the introduction of its Mental Health Reforms. There is one simple method by which this can be achieved. This is, by ensuring that money designated for commissioning Mental Health Services by Central Government be ring-fenced for this purpose, and that it should not be placed in a general fund which could be used for purposes other than that for which it is intended. Yours Sincerely Mark Agius Associate Specialist Address for correspondence; Luton Early Intervention Team. Charter House Alma Street Luton LU1 2PJ References Agius M, Martic Biocina S Alptekin K Rotstein V, Morselli P, Persaud A.[The Gamian-Europe Scientific Group] [2005] Basic Standards for Management of Patients with Serious Mental Illness in the Community. Psychiatria Danubina 17;42. Bertolote J McGorry P [2005] Early Intervention and recovery for young people with early psychosis: consensus statement. British Journal of Psychiatry 187 [Supplement 48] s116-s119. IEPA Writing Group [2005] International Clinical Practice Guidelines for Early Psychosis . British Journal of Psychiatry 187 [Supplement 48] s120-s124. McGorry P, Nordentoft M, Simonsen E [2005] Introduction to ‘Early Psychosis: a bridge to the Future’. British Journal of Psychiatry 187 [Supplement 48] s1-s3. WHO Declaration on Mental Health in Europe 2004. Competing Interests. Mark Agius is a member of the RCPsych General and Community Faculty Committee with a special interest in Early Intervention in Psychosis.