Early Psychosis Intervention in Routine Service Environments: Implications for Case Management and Service Evaluation

摘要

Although there are a number of demonstration early psychosis intervention (EPI) programs, comprehensive procedures for implementing EPI in routine community service environments have not been published. The present study describes the introduction and evaluation of a specialized EPI program in a routine Australian urban mental health service. The program was supported by enhancement funding for 18 months (December 1995 to June 1997) and consisted of four full-time staff and two quarter-time consultant psychiatrists who worked in an Assertive Community Treatment team framework. Of 161 referrals, 149 were assessed and 70 clients were actively treated. Clients showed statistically significant short-term (3-6 months) improvements on all outcome instruments. Detection and retention rates for the specialized EPI program appeared to be better than those for an adjacent service that used a case-manager-implemented EPI protocol but without additional resources or dedicated staff. Preliminary results of a medium-term (3-4 years) follow-up indicated that the social, but not the vocational, function of clients was greatly improved. The authors concluded that the appropriate level of specialized treatment and evaluation required for early psychosis intervention is only possible if models of specialized case management are used and there is a long-term commitment by the mental health service to support early psychosis intervention as a specialized function. Recommendations for the successful introduction and evaluation of early psychosis intervention are discussed.