Early intervention in psychosis is generally offered to young patients experiencing first episode psychosis (FEP) or prodromal symptoms of psychosis. The aim of this pilot study was to explore the impact of early intervention services in patients with FEP ages 35-65. The study is in response to the guidelines put forth by the National Institute of Clinical Excellence in the UK that recommend early intervention be available to any person experiencing FEP, regardless of age. The study sample consisted of 72 patients experiencing FEP over the age of 35. Data on hospitalizations, self-harm or harm to others, employment status, social supports and physical health comorbidity were collected at 1-year follow-up. Results from the study suggest that patients with FEP over the age of 35 represent a sizeable proportion of those referred for early intervention services, and significantly impacted provider caseloads. The researchers suggest that offering early intervention services to patients in the age range included in the study be accompanied by an increase in resources in order to ameliorate the impact on providers’ caseloads and enable them to continue to provide high quality care. Results also indicate that early intervention services may be indicated for patients in this age range, as participants benefitted from these services in many areas of functioning. The researchers added that early intervention should include trauma services as they found that the majority of patients in the sample reported a history of trauma. In addition to these suggestions, the researchers emphasize that patients with FEP in this age range be offered vocational training to support occupational functioning.

Greenfield, P., Joshi, S., Christian, S., Lekkos, P., Gregorowicz, A., Fisher, H. & Johnson, S. (2016). First episode psychosis in the over 35s: is there a role for early intervention? Early Intervention in Psychiatry, 1-7. doi: 10.1111/eip.12322

An exploration of what services users value about early intervention in psychosis services

This study aimed to explore the aspects of early intervention in psychosis services that service users found to be most valuable. A small sample of services users answered questions about their experiences with early intervention services, and the researchers found four areas that were described as being the most valuable: therapeutic relationship, medication, psychological interventions, and practical help and support. Of these, the researchers found that the most important factor cited by services users was therapeutic relationship. These findings are helpful in determining the factors that support services users in continued engagement with treatment, and can ultimately lead to improved treatment outcomes.

Barr, K., Ormrod, J. & Dudley, R. (2015). An exploration of what services users value about early intervention in psychosis services. Psychology and Psychotherapy: Theory, Research and Practice, 88, 468-480. DOI:10.1111/papt.12051

Funded by the Connecticut State Department of Mental Health and Addiction Services (DMHAS), the STEP Program (www.step.yale.edu) has, since 2006, provided a model of Coordinated Specialty Care (CSC) to young people and families confronting the new onset of a psychotic disorder. In 2013, STEP completed the first U.S. randomized controlled trial of such care, reporting a 48% reduction in risk of psychiatric hospitalization in the first year after entry into the service, along with reductions in total number and duration of hospitalizations. Also, individuals receiving STEP care were markedly less likely (<10%) to drop out of the labor force compared to usual care (>30%). Following on these results, additional funding from DMHAS allowed conversion to a permanent service offering in 2014. In 2015, STEP launched a 3-year campaign to shorten the duration of untreated psychosis (DUP) in 10 surrounding towns. This addition of early detection to an established CSC model will test a comprehensive early intervention service for psychotic disorders. The campaign, funded by the National Institutes of Health (NIH) is called Mindmap (www.mindmapct.org) and includes media messaging, outreach to community stakeholders and performance improvement approaches that all aim to halve historical delays into STEP care.

STEP attempts to engage into care all individuals between the ages of 16-35 in the target region who are within 3 years of psychosis onset. Two years of free care is offered to all, irrespective of insurance status, and includes diagnostic evaluation, medications, individual psychotherapy, groups targeting social cognition deficits, family education and services to support educational and employment goals.

The goal of STEP is to build a population health-based system of care in a defined region (population 400,000) by engaging a regional network of clinical and non-clinical care providers to transform pathways to and through care. We aim to model a cost-effective approach to early intervention that is primed for dissemination.

Over the past 10 years, STEP has assisted in the establishment of new services and provided consultation to established programs. We are currently building an online platform to support dissemination of this model of care. Learn more about the STEP Program: www.step.yale.edu