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Advances in Psychiatric Treatment (2005) 11: 71-78
© 2005 The Royal College of Psychiatrists

Early intervention in psychosis: obstacles and opportunities

Swaran P. Singh and Helen L. Fisher

Swaran P. Singh is a senior lecturer in the Department of Mental Health at St George’s Hospital Medical School (Jenner Wing, Cranmer Terrace, London SW17 0RE. E-mail: s.singh{at}sghms.ac.uk) and honorary consultant psychiatrist and clinical lead of the South West London and St George’s Mental Health NHS Trust Early Intervention Service (ETHOS). His research interests include epidemiology, onset and outcome of psychosis, cultural and ethnic factors in mental health, health service development and evaluation, and liaison between primary and secondary services. Helen L. Fisher is a research worker with the Lambeth Early Onset Service’s Crisis Assessment Team (LEO–CAT). Her research interests include the evaluation of services for young people with psychosis and the impact of first-episode psychosis on siblings.

By focusing therapeutic effort on the early stages of psychotic disorders, effective early intervention should improve short- and long-term outcomes. Strategies include pre-psychotic and prodromal interventions to prevent emergence of psychosis, detecting untreated cases in the community and facilitating recovery in established cases of psychosis. The evidence base for each of these strategies is currently limited, although several international trials are under way. The Department of Health in the UK has announced the intention of setting up 50 early intervention services nationally, several of which are already operational. In this article, we briefly discuss the differing ways in which early intervention is conceptualised, summarise the evidence supporting it in established cases of psychosis, suggest appropriate service models and describe two early intervention services in south-west London.




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