One‐year outcome of an early intervention in psychosis service: a naturalistic evaluation

Abstract

Dear Editor, We are grateful to Aguis et al. for their interest in our paper and their words of support. The positive results of their Bedfordshire service are further demonstration that in the ‘real world’, EI services make a substantial and positive difference to the lives of our patients. The difference between their service and our London service in skill-mix, interventions offered and outcomes suggests the need for research that can delineate the specific ‘therapeutic ingredients’ of early intervention. Should such a core complex of interventions be identified, it can become the basic package of care offered by all EI services, regardless of the local context. We wholeheartedly endorse their recommendations for EI services to be multi-modular and truly comprehensive, spanning the entire spectrum of care from early detection in the prepsychotic phase to youth focused inpatient care and assertive recovery and rehabilitation. We have come a long way from the initial scepticism when early intervention was considered a waste of valuable resources, with randomized trials convincingly demonstrating the clinical effectiveness of EIS. The risk now is of a complacent assumption that EI services are ‘sorted’ and attention can move elsewhere. Innovative models of care need long-term nurturing and investment if these are to provide a sustainable service over time. As pressures mount in other parts of the health service, there is a worry that commissioners and managers will gradually withdraw resources from EIS, or dismantle the service under the guise of redistributing skilled EI clinicians into generic teams. We also urgently need high quality data on the cost-effectiveness of EI services as compared with standard care so that a robust case can be made for long-term investment into EIS.