Early intervention for psychosis may cost more upfront, but offers a better return on investment


Psychotic illnesses such as schizophrenia cause severe distress and suffering for those who suffer from them and for their families.

Too often, these diseases prevent those affected from completing their education, starting to work or keeping a job, and participating in their community.

This can lead to impoverished lives and premature death, due to suicide or preventable physical health problems. People with psychotic illnesses die up to two decades earlier than those unaffected by these conditions.

Read more: Physical health ignored in people with mental illness

These poor results are not only an integral part of the disease. Applying the strategies used to treat other illnesses – such as early diagnosis and early stage intensive care – can prevent psychotic illnesses from progressing or becoming lifelong conditions.

Such care can be more expensive than standard and deferred mental health care. But when you consider the economic gains from lower levels of disability, early intervention for psychosis offers a substantial return on investment.

Repair an obsolete system

Mental health care reforms for psychosis began in Melbourne over 30 years ago.

At the time, standard management for people with their first episode of psychotic illness started late and often resulted in traumatic experiences for the young person, demoralization and increased risk of suicide.

Standard mental health services were dominated by middle-aged patients with long-term illness. Treatments were crude and limited, focusing on symptom management.

What were the goals of early intervention?

Early intervention for youth with psychosis offered hope for recovery through early diagnosis, combined with comprehensive multidisciplinary team care. This included psychiatrists, psychologists, social workers, occupational therapists and others.

These services would be maintained for the critical period of the first few years after diagnosis.

Early intervention aimed to provide sustained early care, rather than simply treating symptoms after they appeared.

Early intervention offered a number of potential advantages over standard care, including:

  • early diagnosis before the disease produces entrenched injury and disability
  • to be treated with more care and respect
  • be exposed to a culture of hope and optimism
  • have the family included and supported
  • prioritize finding and maintaining work
  • experience less treatment-related stigma and trauma.

Read more: Welfare to work: a different approach for people with mental illness

Meanwhile, early intervention research has created a scientific process to identify those at risk for developing psychosis and intervene before the disease has full onset.

The aim was to prevent the development of psychosis or, if it did occur, to delay or lessen its impact.

That was the idea, how did it work in practice?

Over the decades that followed, hundreds of early psychosis programs around the world and a range of clinical trials have scientifically evaluated the effectiveness of early intervention for psychosis.

The woman is making coffee in a cafe.
One of the goals of early intervention is to help young people find and keep jobs.
Yasamine June / Unsplash

The programs target the early stages of the disease and produce marked benefits in most patients.

This approach has shown:

Above all, these programs are extremely popular with young people and families.

But interventions can’t stop suddenly

Recovery achieved through early intervention must be supported by continued care throughout the critical early years of illness.

The first wave of early intervention research and reform created programs that offered this enhanced care for only two years. When people were discharged and started receiving standard care, some of the gains were lost.

More recent research has shown that if the high quality of care provided by early psychosis programs is extended for another three years (so five years in total), the gains are sustained.

Some critics argue that getting these functional results at the onset of psychosis is not worth it if it takes effort to maintain it.

This is like saying that it is not worth going into remission from cancer, because if treatment is stopped or downgraded too soon, relapse occurs.

Young people in a conference room put sticky notes on a whiteboard.
Early management of psychosis requires effort to maintain results.
Jason Goodman / Unsplash

The best way to interpret the evidence is to recognize that for a substantial subset of patients, the disease is persistent or recurrent. Therefore, after achieving an early positive result through early intervention, it is essential to make every effort to maintain it.

Most patients require an intervention longer than the initial two-year window of early psychotic care.

Early intervention saves money as well as the future

Over 20 economic analyzes of early intervention in psychosis have shown a substantial return on investment.

While early care for psychosis is naturally more expensive than substandard deferred care in generic settings, clinical outcomes are significantly better than standard care, as shown by studies in Denmark, the United States and the United States. Australia.

Read more: Anxiety and depression in young people has reached record levels. Mental health centers could be the answer

And when you factor in the savings from reduced rates of functional and social disability – which alters family and social relationships – the overall economic outcomes are also better.

This is due to reduced reliance on social assistance, higher tax revenues through employment, and reduced costs associated with suicide, delinquency and incarceration.

A recent evaluation by the Australian Early Psychosis Youth Services (EPYS) concluded that these health services were not cost effective.

However, he did not really conduct a cost benefit study, just listing the costs alone. It also failed to take into account the economic benefits associated with employment, education and justice – and the authors acknowledged this shortcoming.

When considering the economics of early intervention, it is important that functional and social recovery is included – meaning that a person can work or study and participate more fully in society – rather than just recovery. symptoms and direct health care costs.

Importantly, the evaluation found that young people with psychosis and their families highly value the early intervention approach, which helps them pursue their hopes and dreams of a meaningful and fulfilling life.

If this article has raised any issues for you, or if you are concerned about someone you know, call Lifeline on 13 11 14.


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