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Is early intervention for psychosis a waste of valuable resources?

  • Anthony J. Pelosi (a1) and Max Birchwood (a2)
Extract

The concept of early intervention for psychosis has received much attention in recent years. The experience of pioneer services in the USA and Australia has convinced the UK Government to set aside millions of pounds to make dedicated early intervention teams an integral part of standard mental health services across the country. Other governments are set to follow suit. The rationale for early intervention is that there is a higher success rate if psychotic symptoms are treated early than if they are treated after they have been present for some time. It is also claimed that interventions early in the course of the illness can decrease the psychosocial impact of a psychotic illness that leads to secondary disability. But have these assertions been empirically demonstrated? Do such services simply take valuable resources, both in terms of funding and staff, from an already-overstretched mental health system, or do they change the trajectory of the disease process in a fundamental way? Dr Max Birchwood, Director of the Birmingham Early Intervention Service, and Dr Anthony Pelosi, consultant psychiatrist with a ‘generic’ community service in East Kilbride, Scotland, debate this issue.

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References
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Birchwood, M., McGorry, P. & Jackson, H. (1997) Early intervention in schizophrenia. British Journal of Psychiatry, 170, 25.
Birchwood, M., Fowler, D. & Jackson, C. (eds) (2000) Early Intervention in Psychosis. A Guide to Concepts, Evidence and Interventions. Chichester: John Wiley & Sons.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Is early intervention for psychosis a waste of valuable resources?

  • Anthony J. Pelosi (a1) and Max Birchwood (a2)
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eLetters

Invest in CMHTs or sub-specialist teams?

Erik C.R. Milner, Consultant Pychiatrist in Assertive Outreach and Rehabilitation
04 March 2003

Pelosi/Birchwood`s (2003) debate, “Is early intervention for psychosis a waste of valuable resources?” made for interesting reading. However, it rehearsed many of the previously proposed arguments with respect to the development of other sub-specialist teams. Similar themes have emerged for example in the debate around assertive outreach services.Crisis intervention services have been relatively spared, perhaps due to their predicted more direct effects on bed usage and the alleviation of the emergency workload of generic teams.

Pelosi makes veiled references to protected caseloads by the use of the terms "leisurely work" by "these least industrious of all evangelists". Are protected caseloads so out of reach for generic CMHTs, that their very existence within sub-specialist teams is frowned upon? More specifically Pelosi attacks the notion of a "critical period", an argument that is well countered in Birchwood`s argument against the motion. One senses that novel formulations that may not be wholly consistent with standard patterns of working tend to be all too readily dismissed without adequate consideration of the evidence.

It would appear that many CMHTs have a limited ability to prioritise those with psychosis in relation to illness severity, disengagement and crises, and have difficulty providing for targeted input at the time of initial diagnosis. Whilst such a predicament persists, are generic CMHTs in a strong position to question the development of sub-specialist teams given the tasks of directing input on these self-same foci?

Pelosi,A./Birchwood M. (2003) Is early intervention for psychosis a waste of valuable resources? British Journal of Psychiatry, 182, 196-198.
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Conflict of interest: None Declared

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