This is an excerpt of an article from the January/February edition of Mental Health Today - to read the full article subscribe to the magazinehere.
In England about 200,000 people have schizophrenia, more than one million have bipolar disorder and related conditions, and there are nearly 7,000 new cases of these conditions each year (McCrone et al, 2008).
The origins of psychosis are frequently in childhood and adolescence and early signs can often go unnoticed. Identifying the early signs of psychosis is clearly challenging but so is providing appropriate care once psychosis has 'emerged'. It has been demonstrated that the duration of untreated psychosis (DUP) is long with an average period of about two years before treatment commences (Marshall et al, 2006).
In other clinical areas great emphasis is placed on providing treatment as early as possible due to the recognised adverse impact of delayed care. The impact of delaying treatment for serious physical health problems can be evident and for psychosis it has also been shown that a prolonged DUP is associated with poorer long-term outcomes (Marshall et al, 2006; Perkins et al, 2005).
Given the above, there has been much recent emphasis placed on providing treatment at an earlier stage. Early detection (ED) services seek to identify people who are at risk of developing psychosis, provide appropriate treatment to reduce the likelihood of such a 'transition', and improve health if it does occur. These services are relatively rare and some would question their appropriateness. Most people with prodromal symptoms do not actually go on to develop full psychosis and therefore providing treatment, such as antipsychotic medication and/or psychological therapies, may raise ethical issues.
However, medication for these patients is often at a low dose and the fact that most will not develop full psychosis does not mean that they are not presenting with quite serious health problems that can still benefit from treatment. Clearly, an important task is to identify risk indicators with greater precision so that targeting of care provided by ED services can improve.
More common are early intervention (EI) teams, which provide support to patients who have already developed psychosis. These teams tend to treat patients for up to three years and provide a mixture of medical, social and vocational support. The latter is crucial given that most patients are relatively young and enabling them to be economically active has benefits to themselves and to wider society. In England in 2001, the then Labour Government mandated the development and provision of three forms of specialist community mental health team, one of which was EI teams (Department of Health, 2001).
EI services, along with other specialist mental health teams, clearly come with a cost and two crucial questions are:
•Are these extra costs offset by reduced costs elsewhere in the health and social care system, or indeed the wider economy?
•Even if costs are higher, are these justified by sufficiently improved patient outcomes?
These questions are important to ask of any innovative service or treatment because resources are scarce and yet demand for those resources is fairly unlimited. This has always been the case but is particularly apparent in the current climate of economic austerity. Given that research funding organisations generally require issues of cost-effectiveness to be investigated it is somewhat surprising the encouragement to establish early intervention services was based on little economic evidence ...
To read his full thoughts and for references, pick up your copy of Mental Health Today Jan/Feb 2012 here.
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