What are early intervention services and who are they for?

Professor Philip McGuire: Early intervention services for psychosis are for people who may be at risk of developing a psychotic disorder or who have just developed a psychotic disorder and the main purpose of these is to provide help and information and support at the earliest stage possible. Sometimes, even before an illness has developed. And the rationale for that is that there is increasing evidenced that the sooner you deliver interventions in psychotic disorders, the better the chance of having a good outcome. 

So early intervention services are being sort of rolled out across the UK as a kind of national policy, so in theory most major centres are obliged to provide some kind of early intervention service. And in practice, most major centres do provide some form but it varies quite a lot from place to place, depending on the resources available.

I am the clinical director of OASIS, which is an acronym that stands for Outreach and Support in South London. So OASIS is an example of an early intervention service that focuses on people who are at high risk of psychosis but are not actually psychotic.

And the way the service operates is slightly different from a typical mental health scene in that most of the contact with the clients is in primary healthcare, so that means they are usually seen in their local general practice building and often the referral to the service comes from the client’s own GP.

A proportion of people who present to OASIS, all of the people who present are at a very high risk, hundreds of times more than normal, of developing a psychosis and the risk of psychosis is really mainly in the next 2 years. So one of the objectives of OASIS is to provide the maximum amount of input over that first 2 years which is seen as critical.

Now a minority of people, despite intervention, may develop a psychosis during that period. If they do, the big advantage for the client is that they are already engaged with a mental health service, so the delay that they you typically see for the initiation of treatment for a frank psychotic disorder doesn’t really happen, so normally in the UK there’s a period of about a year between the first onset of a psychotic disorder and the start of treatment, and that’s called the ‘duration of untreated psychosis’.

If you engage people when they are in the high risk stage, we have been able to reduce that delay to a matter of days, because we are already seeing the client, they already know all about psychosis and they can recognise the symptoms if they do occur very early, and they often feel very comfortable about receiving treatment for that, because they are familiar with what’s going on and often the treatment is being offered at a stage when the illness is in a relatively mild form, as opposed to if you wait, say a year later when people are going to be floridly unwell and may be relatively lacking in an understanding of what’s happening to them and may not want to have treatment.

Once somebody becomes psychotic, with a psychotic disorder, then what normally happens with OASIS is that we would arrange for that individual to be taken on by one of the first episode Early Intervention teams. So early intervention teams are really comprised of 2 kinds of services – services like OASIS, for people who are very vulnerable to psychosis, and services for people who have a definite established first episode of psychosis, so if somebody became psychotic while under the care of OASIS, they would eventually be transferred to a first episode team, who specialise in the treatment of that.

In many parts of the UK, there isn’t a separate service for high risk individuals and a separate service for first episode clients, they are often merged into a kind of general early intervention team and that’s usually because of limited resources.