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June 2018

Early Intervention—An Implementation Challenge for 21st Century Mental Health Care

Author Affiliations
  • 1Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
  • 2Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
JAMA Psychiatry. 2018;75(6):545-546. doi:10.1001/jamapsychiatry.2018.0621

For many decades, early intervention (EI) has been a central pillar of treatment of all the major physical noncommunicable diseases (NCDs). Early intervention can be defined as diagnosis at the earliest possible point, even presymptomatically, followed by proportional or stage-specific intervention adapted and sustained for as long as is necessary and effective. This strategy has been a major factor in increased survival and better outcomes seen in cancer and cardiovascular disease (CVD), among other conditions. Mental illness is increasingly recognized as the NCD with the greatest effect on human potential and economic productivity1 because its timing early in the lifespan and consequent long period of morbidity results in a substantial reduction of life expectancy both directly and indirectly (via physical illness). Mental illness is responsible for the largest contribution to disability-linked disease burden.1 Yet the curve of mortality and morbidity has not changed, even in developed countries. In these circumstances, an obvious question is why, given the lessons from cancer and CVD, has EI not been an absolutely top priority? We have effective treatments, but they are typically deployed late and without the strategic goal of reducing progression of illness. Provided that each stage of illness treatment is proportional (that is, adapted to maximize benefits and minimize risks), then EI in mental health care and specifically in care of psychotic illness more than qualifies for a green light. Yet it has been a long hard road to build momentum to make EI for psychotic disorders a standard feature of mental health care.

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