Building Early Intervention Services for Psychotic Disorders: A Primer for Early Adopters in the U.S.

Abstract

Recent developments in the U.S. healthcare policy signal a growing commitment to early intervention for psychotic disorders. A growing international and U.S. research database supports the effectiveness of specialty team-based models adapted to care for young individuals with recent onset psychosis. The RAISE (Recovery After an Initial Schizophrenia Episode) initiative, sponsored by the NIMH (National Institute of Mental Health), has defined such Coordinated Specialty Care (CSC) services as a new benchmark for care across the U.S., and published a variety of resources to support dissemination. Funding initiatives led by the center for Substance Abuse and Mental Health Services (SAMHSA), and support from other national organizations, have catalyzed interest in community agencies across the country. We offer guidance to such early adopters and supplement extant resources with a focus on the process of setting up such programs. Adopters have numerous decisions to make. These include determining admission criteria, structuring care processes to maximize impact, choosing from several empirically based interventions, and resourcing workforce development. We provide a guide to salient resources, and lessons learned from a decade old CSC, to aid in these complex decisions. We end with a discussion of limitations in the current knowledge base, and the need for responsive research. Early intervention services can engender application of demonstrably effective treatment, while also providing platforms for research to improve and develop new treatments. Collaborations between a wide variety of government, academic and commercial stakeholders will be essential to realize the transformative public health impact of early intervention for psychotic disorders.