Where is the evidence for incorporating early intervention treatment into the CMHT?

Abstract

Although it is gratifying to be regarded as the ‘best of the staff’ by someone as esteemed as Professor Peter Tyrer, I take issue with the suggestion that early intervention teams (EITs) should be broken up and their functions incorporated within a flexible community mental health team (CMHT).1 Following the principle of ‘Let Wisdom Guide’, one would like to see the evidence before taking such a step. For while it may be true that assertive outreach teams and other innovations in Britain proved disappointing for some of the reasons outlined in the article, this is not the case for early intervention. For example, there is evidence that EITs reduce hospital admission compared with CMHTs2 and that once patients are transferred back to CMHTs, the admission rate goes up again.3 If we have a service model of proven effectiveness, particularly in reducing demand on the most expensive elements of mental healthcare (in-patient beds), such as EITs, why switch to an unproven service model? One can make a tentative case that the superior outcomes are due to ‘better skilled’ EITstaff or to the extra resources these teams have – which the McCrone paper shows pays for itself by reducing demand3 – but a wise approach suggests waiting for evidence of effectiveness of these CMHTs with EIT functionality before ploughing ahead and dismantling an evidence-based superior service.