International declarations that articulate core values, goals and standards have played an important role in enhancing the quality of care in a number of areas of medicine.This document attempts this task for early intervention in psychotic disorders.It was originally inspired by the St Vincents declaration on the care of diabetes and carefully developed by David Shiers and Jo Smith with support from the Initiative to Reduce the Impact of Schizophrenia, National Institute for Mental Health in England and Rethink, resulting in the UK-focused Newcastle Declaration. The World Health Organization and the International Early Psychosis Association then collaborated to produce an international version of the declaration, which articulates the universal principles of early intervention and tries to blend these with local capacities and cultural diversity.
According to the World Health Organization’s World Health Report 2001 (World Health Organization, 2002), schizophrenia and other forms of psychoses that affect young people represent a major public health problem. Worldwide, they rank as the third most disabling condition (following quadriplegia and dementia and higher than blindness and paraplegia) and pose an enormous burden, both in terms of economic cost and of human suffering.
Yet, despite the availability of interventions that can reduce relapses by more than 50%, not all affected individuals have access to them, and when they do, it is not always in a timely and sustained way. Among the goals of care to these people, the identification of the illness and its treatment, as early as possible, represents a high priority.
Comprehensive programmes for the detection and treatment of early psychosis and in supporting the needs of young people with early psychosis carry the important function of promoting recovery, independence, equity and self-sufficiency and of facilitating the uptake of social, educational and employment opportunities. These programmes can be provided by individuals and teams with specialised skills, with a full range of primary healthcare services for every young person with early psychosis.
Prompt and effective interventions for young people with early psychosis, for their families, close friends and other carers represent a major element of respect of individuals’ rights to citizenship and social inclusion.
Fundamental objectives derived from this statement are to:
Challenge stigmatising and discriminatory attitudes so that young people are not disadvantaged by their experiences and are truly included in their local communities.
Generate optimism and expectations of positive outcomes and recovery so that all young people with psychosis and their families achieve ordinary lives.
Raise wider societal awareness about psychosis and the importance of early intervention.
Attract and encourage practitioners from a wide range of health, social, non-governmental agencies (e.g. charitable, voluntary and youth), educational and employment services to reflect on how they can better contribute to supporting young people with psychosis, their families and their friends.
Programmes for the detection and treatment of early psychosis should value:
Respect of the right to recovery and social inclusion and support for the importance of personal, social, educational and employment outcomes.
Respect of the strengths and qualities of young people with a psychosis, their families and communities, encouraging ordinary lives and expectations.
Services that actively partner young people, their families and friends to place them at the centre of care and service delivery, at the same time sensitive to age, phase of illness, gender, sexuality and cultural background.
Use of cost-effective interventions.
Respect of the right for family and friends to participate and feel fully involved.
A 5-YEAR PROGRAMME OF ACTION
This consensus statement describes (Table 1) a number of 5-year measurable outcomes that an individual and their family can expect from services who have successfully implemented a comprehensive and effective programme.
Attaining these 5-year outcomes will require underpinning by modern technical interventions and actions:
A series of interventions has demonstrated efficacy in the management of early psychoses, among which there are pharmacological and psychosocial approaches, the latter addressed to both patients and family members (International Early Psychosis Association – IEPA – consensus statement, 2002).
Some of these interventions are specified, by level of resources in a given area, in Table 2, according to the recommendation put forward by the World Health Organization’s World Health Report 2001. In the same Annex are found strategic actions needed/useful for the implementation of those interventions.
- © 2005 Royal College of Psychiatrists