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Early intervention and recovery for young people with early psychosis: consensus statement

  • J. Bertolote (a1) and P. Mcgorry (a2)

Summary

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.

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Copyright

Corresponding author

Professor P. McGorry ORYGEN Research Centre, Locked Bag 10/35, Poplar Road, Parkville, Victoria 3052, Australia. Tel +61 3 9342 2921; fax +61 3 9342 2921; e-mail: mcgorry@ariel.unirnelb.edu.au

Footnotes

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1.

This document is based on the UK Newcastle Declaration (2002), an idea conceived by IRIS, the Initiative to Reduce the Impact of Schizophrenia, and further developed with the support of Rethink and the National Institute for Mental Health in England.

Paper presented at the Third International Early Psychosis Conference, Copenhagen, Denmark, September 2002.

Footnotes

References

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Consensus Statement on Principles and Practice in Early Psychosis (2002) In Implementing Early Intervention in Psychosis: A Guide to Establishing Early Psychosis Services (eds Edwards, J. & McGorry, P. D.), pp. 145155. London: Dunitz.
The Newcastle Early Psychosis Declaration (2002) http://www.rethink.org/newcastledeclaration
World Health Organization (2002) World Health Report 2001. Mental Health: New Understanding. New Hope Geneva: WHO.

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Early intervention and recovery for young people with early psychosis: consensus statement

  • J. Bertolote (a1) and P. Mcgorry (a2)
Submit a response

eLetters

Implementing Early Intervention In The UK

Mark Agius, Associate Specialist
10 August 2005

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 ofHuman 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 organisationfor 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 ofthe doubts of many clinical colleagues who have doubted the evidence. Moreimportantly, 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 feltfree to divert Mental Health Resources to other priorities which have beenviewed as being more pressing, or even to ‘Achieve Financial Balance’. Onecannot 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 beused for purposes other than that for which it is intended.Yours SincerelyMark Agius

Associate Specialist Address for correspondence;Luton Early Intervention Team.Charter HouseAlma Street Luton LU1 2PJ

ReferencesAgius 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 ofPsychiatry 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.
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Conflict of interest: None Declared

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