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Viewpoint |

Early Intervention for Psychotic Disorders Building Population Health Systems

Vinod H. Srihari, MD1,2; Anant Jani, PhD3; Muir Gray, MD3
[+] Author Affiliations
1Department of Psychiatry, Yale University, New Haven, Connecticut
2Program for Specialized Treatment Early in Psychosis, Connecticut Mental Health Center, New Haven
3Department of Primary Care, University of Oxford, Oxford, England
JAMA Psychiatry. 2016;73(2):101-102. doi:10.1001/jamapsychiatry.2015.2821.
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This Viewpoint proposes a conceptual framework for population health systems that would enable early intervention services for patients with new-onset psychotic disorders.

Treatment works; the earlier, the better. The intuition that, if applied early in the course of illness, available treatments for the schizophrenias will leverage greater reductions in distress and disability has survived rigorous testing over the past decade. Four randomized controlled trials, in as many different countries (including the United States), have demonstrated the impact of comprehensive services that adapt evidence-based pharmacologic and psychosocial approaches to reach young persons and their families as they confront the onset of a psychotic illness.1 A pioneering Scandinavian project also established the independent value of reducing delays to care.2 Although preventing the onset of psychosis in “high-risk” or prodromal individuals is a valued aspiration, early intervention (EI) for manifest psychotic illness is a tractable goal with growing support in the United States. The Consolidated Appropriations Act of 2014 directed the Substance Abuse and Mental Health Services Administration to set aside funds for EI even as a National Institutes of Health initiative demonstrated feasibility across 21 states and published detailed implementation manuals (http://www.nimh.nih.gov/raise). The related project of developing services to reduce delays to care has been catalyzed by another National Institutes of Health research initiative. Also, 2 bipartisan mental health care reform bills, currently making their way through the US Senate and the House of Representatives, envision EI as an essential component.

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