Mental health early intervention projects offer 'outstanding value'

Please click on the image to magnify it.

An article posted on April 20th by Children & Young People Now:

Having early intervention psychosis teams work with young people experiencing their first episode of schizophrenia or bipolar disorder can save as much as £18 for every £1 spent.

By Joe Lepper

Taxpayers save £8 for every £1 spent on parenting programmes, according to the latest study into the value of early intervention mental health projects.

The study by the Department of Health, London School of Economics and Political Science, the Centre for Mental Health and Institute of Psychiatry found savings increased as the mental health support became more specialised.

It is estimated that £18 is saved for every £1 spent on deploying early intervention psychosis teams to work with young people experiencing their first episode of schizophrenia or bipolar disorder.

Suicide training for GPs saves £44 and alcohol misuse schemes save £12 for every £1 spent.

Called Mental Health Promotion and Mental Illness Prevention: the Economic Case, the study puts the economic and social cost of mental health problems, through factors such as offending rates and benefit payments, at £105bn a year.

Care services minister Paul Burstow said: "Mental health is not a matter of them and us, it’s about all of us. At some point one in four of us will suffer a mental health problem.

"PCTs and GP Consortia should take a careful look at this study and use it to commission better mental health services."

The research team looked at 15 different mental health projects. Team leader Professor Martin Knapp said they all offer "outstandingly good value for money".

He added: "Most are low in cost and many become self-financing over time, saving public expenditure as well as radically improving the quality of people’s lives."

Also see:

What’s it worth now?

Early warning signs of schizophrenia

An article published today by the Boston Globe:

By Emily Anthes

These symptoms, alone or in combination, do not necessarily mean that a child has psychosis or psychosis risk syndrome. But they may indicate a need for evaluation.

• Mild hallucinations or delusions, often accompanied by the awareness that the experience is not real. Teens may feel as though they are being followed, for instance, even though they know that’s probably not true.

• Strange bodily sensations, such as the feeling that one’s brain is bouncing back and forth inside the skull.

• Difficulty focusing mentally, especially if this is a new problem. A sudden diagnosis of attention deficit disorder in an older teen or young adult can be a red flag.

• Other cognitive difficulties, such as trouble remembering. People with psychosis risk syndrome often complain that their minds aren’t “working right.’’

• Social withdrawal and isolation.

• Trouble sleeping.

• Blunted facial expressions or a blank gaze.

• Any other sudden changes in interest, activity, or functioning.

Screening children for mental illness

In 2008, Massachusetts began requiring doctors to offer mental health screening to all children on MassHealth, the state’s Medicaid program, during checkups. The number of children screened has been steadily increasing, reaching more than 60 percent of those who had checkups in the first quarter of this year. Of those screened, 8 percent to 10 percent might need further attention, says Emily Sherwood, director of the state Children’s Behavioral Health Initiative.



Please click on the image to magnify it.

Also see:

Getting ahead of trouble


Image credit

McGorry urges mental health overhaul

An article published in today's edition of The Sydney Morning Herald:

By Julia Medew

The Australian of the Year, Patrick McGorry [pictured], has called for a massive overhaul of the mental health system to direct funds away from acute hospital services to more community-based care.

Only weeks after accepting his award, Professor McGorry has moved to capitalise on his role by asking the federal Health Minister, Nicola Roxon, for at least $200 million in new services this year.

On top of his list is a significant expansion of specialised treatment facilities for young people aged 15 to 24 who are experiencing early psychosis and other serious mental health disorders such as schizophrenia.

He said the only such facility in Australia, Orygen Youth Health, should be used as a model for 10 new centres in other cities this year, with a commitment to another 10 in regional hubs over the next five years.

The rollout would cost $100 million this year, he said, with recurrent spending rising to about $250 million a year when all 21 centres are operating.

"This investment will be recouped three times over because early intervention is highly cost-effective and rapidly shrinks the need for care in the medium to long term," he said.

"This will free up resources for the long-term disabled cases and the broader range of mental disorders. The health economics case is unassailable."

Professor McGorry, who directs Orygen Youth Health, said he had also asked for 60 new "headspace" centres, which currently provide mental health, education, employment and drug and alcohol services to young people aged 12 to 25 at 30 sites across the country.

He said this expansion, which would cost $100 million to set up and the same in recurrent spending, would make headspace centres the first port of call for young people showing signs of mental illness, who could then be referred on to the specialised treatment facilities if need be.

"This is a low-risk reform strategy with rapid and dramatic benefits in health gain and cost savings. Failure to invest in early psychosis reform will result in another lost generation of young Australians consigned to unnecessary disability as well as premature death from suicide and cardiovascular disease," he said.

Professor McGorry said he wanted to see the centre of gravity of mental health services shifted away from hospitals to community-based facilities because the sector had suffered enormously from being moved out of "asylums" and into hospitals in the 1990s. He said the transition was like "boarding a sinking ship" for mental health professionals who had struggled to work with scarce funds ever since.

''The acute pressure [on the hospital system] has made mental health budgets very vulnerable,'' he said. ''The mental health system needs to be scaled up significantly now. It needs to double in size and the states can't do it alone.''

Professor McGorry said that after consulting widely in recent weeks, he also hoped federal and state and territory governments would fund more mobile treatment teams for people with delayed recovery and persistent conditions so they were not forced to go to hospital emergency departments during crises.

"We need to disinvest in emergency departments as the place for acute and crisis care. EDs are the wrong places for people with mental health problems to be treated," he said.

Photo credit

Early and network-oriented care may help adolescents at risk of developing psychosis

A press release posted May 14th by EurekAlert:

Family and network oriented, stress-reducing care improves level of overall functioning and mental health in adolescents at risk of developing psychosis, suggests a recent Finnish study.

Jorvi Early psychosis Recognition and Intervention (JERI) project at Helsinki University Central Hospital (HUCH), Jorvi Hospital, Finland, is a project with an early intervention team for adolescents at risk of developing first-episode psychosis. As developing psychosis has been suggested to be a result of a combination of acute life stressors and trait-like vulnerability to psychosis, the intervention is based on the idea of multiprofessional, need-adapted, community-, family- and network-oriented, stress-reducing, overall functioning supporting and low-threshold care.

The JERI team meets with adolescents at ages 12-20 in their natural surroundings, e.g. at school or at home, together with their parents and community co-worker, who has originally contacted the JERI team because of unclear mental health problems. The aim of the team is to recognize potential risk cases and reduce the stress level by family and network intervention.

A follow-up study was performed to test how presented intervention will help adolescents at risk. Data was collected between January 2007 and May 2008. During the intervention, mean scores rose statistically significantly on overall functioning and scores on quality of life, depression, anxiety and pre-psychotic symptoms decreased statistically significantly, showing an improvement in overall functioning and mental health in adolescents at risk of developing first-episode psychosis. Adolescents did not receive other therapy or any antipsychotic medication.

"JERI- intervention seems to improve level of overall functioning and support mental health in adolescents at risk of developing first-episode psychosis, even though further study with larger number of subjects, with a proper control group and with a longer follow-up time is needed", says Dr. Niklas Granö, the leader of the research.

###

Results are published in the journal Early Intervention in Psychiatry.

For further information, please contact:

Niklas Granö, PhD.
E-mail: niklas.grano@hus.fi
Tel. + 358 9 471 83007

Reference:

Niklas Granö, Marjaana Karjalainen, Jukka Anto, Arja Itkonen,Virve Edlund and Mikko Roine: An intervention to improve level of overall functioning and mental condition of adolescents at high risk of developing first-episode psychosis in Finland. Early Intervention in Psychiatry (2009; 3: 94-98)

Landmark Institute of Medicine Report Paves Road to Prevention

An article published in the April 3rd edition of Psychiatric News:

By Mark Moran

American Psychiatric Association (APA) leaders involved with the report say it points to a "paradigm shift" in the way medicine and psychiatry approach mental health and illness in the future.

Prevention of mental illness and promotion of mental health are scientifically feasible, and the time is ripe to transfer the science into practice.

That is the conclusion of a landmark report by the Institute of Medicine (IOM) titled "Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities."

Prevention practices have emerged in a variety of settings, including programs for selected at-risk populations—such as children and youth in the child-welfare system—school-based interventions, interventions in primary care settings, and community services designed to address a broad array of mental health needs and populations, according to the report.

The report updates a 1994 IOM book, Reducing Risks for Mental Disorders, and focuses attention on the research base and program experience with younger populations that have emerged since that time.

The book-length report includes chapters on (among other subjects) using a developmental framework to guide prevention and promotion; perspectives from developmental neuroscience; preventive intervention research—including family, school, and community interventions; prevention of specific disorders; screening; benefits and costs of prevention; and implementation and dissemination of prevention and promotion practices.

APA leaders are hailing the report saying it points to a paradigm shift in the way psychiatry approaches mental illness in the future.

"Both prevention and psychiatry have always been the stepchildren of medicine," said APA President Nada Stotland, M.D. "It is not as glamorous as open-heart surgery or restoring a brilliant individual with bipolar disorder to her career and family. It is much easier to get credit for fixing something that is broken than for keeping it from breaking in the first place. However, most of the improvements in life span are the result of preventive, rather than treatment, measures—immunizations, pap smears, clean air and water, smoking cessation.

"Most health professionals are unaware of the crucial data in the IOM report," Stotland said. "Now that it has been published, and we know that there are effective ways to prevent psychiatric disorders in children, there is no excuse for our country's continued failure to implement the policies that would protect our children from lifetimes of suffering and disability."

Child psychiatrist William Beardslee, M.D., a member of the IOM committee and chair of APA's Corresponding Committee on Prevention of Mental Disorders and Promotion of Mental Health, echoed Stotland.

"This is a landmark report and deserves to be read with care by every psychiatrist," Beardslee told Psychiatric News. "Psychiatry has an opportunity to provide extraordinary leadership in the prevention of mental illness, and we strongly urge APA and individual psychiatrists to support the report's recommendations."

Those recommendations include a call for a coordinated national strategy originating in the White House for implementing prevention and promotion practices.

The IOM report stated, "The White House should create an ongoing mechanism involving federal agencies, stakeholders (including professional associations), and key researchers to develop and implement a strategic approach to the promotion of mental, emotional, and behavioral health and the prevention of mental, emotional, and behavior disorders and related problem behaviors in young people."

Psychiatrist Carl Bell, M.D., also a member of the IOM committee, said that recommendation was modeled on the success of a similar White House cabinet-level strategy during the Clinton administration concerning violence against women.

"What the IOM is saying is that it is possible to prevent psychiatric disorders, substance abuse, and problem behaviors," Bell told Psychiatric News. "The challenge for psychiatry is to shift its paradigm and stop thinking of itself as a field that only treats the sick, but begins to think in terms of a public-health model."

Beardslee and Bell both stressed that the IOM report underscores the importance—and scientific basis—not only of preventing or preempting the occurrence of major mental disorders among individuals who exhibit preclinical symptoms, but also broad population-based strategies aimed at promoting mental health.

Beardslee stressed as well that in the background of all behavioral disorders are the issues of poverty and health disparities.

"Prevention should be a part of regular psychiatric practice," Beardslee said. "I see three levels at which psychiatrists can be putting prevention into practice. As social scientists, we should be embracing the public-health perspective and broad reforms to address health disparities and poverty. A second level where psychiatrists can have a very large impact is in working with adults with mental illness who have children, doing preventive work using psychoeducational models.

"And the third level is the use of preventive strategies that have been designed for people at very high risk."

Early detection of psychosis – Establishing a service for persons at risk

An abstract published in the January 2009 edition of European Psychiatry:

By Frauke Schultze-Lutter, Stephan Ruhrmann, and Joachim Klosterkötter [pictured]

University of Cologne, Department of Psychiatry and Psychotherapy, Early Recognition and Intervention Centre for Mental Crises (FETZ), 50924 Cologne, Germany

Purpose

The establishment phase of an early detection centre for prodromal psychosis is introduced and characterised, along with its detaining and promoting factors within a universal multi-payer health care system.

Method

Across the first six years (1998–2003), users' characteristics are compared between different diagnostic groups and to the local population statistics; and, for an exemplary 12-months period (3-1-2002 to 2-28-2003), the characteristics of telephone contacts with the service are studied.

Results

Rising steadily in number across the first three years, 872 persons, predominately of German citizenship and higher education, consulted the service until 2003, 326 with first-episode psychosis and 144 not fulfilling criteria for a current or beginning psychosis. Of the 402 putatively prodromal patients, 94% reported predictive basic symptoms, 68.9% attenuated and 20.6% transient psychotic symptoms. Most contacts by persons meeting any prodromal criterion were initiated by mental health professionals (psychiatrists or psychologists) and counselling services.

Conclusion

Supported by public awareness campaigns, an early detection service is well received by its users and private practitioners as reflected by the large proportion of referrals from the latter. However, persons of non-German background as well as of lower education were underrepresented indicating that these sub-groups should be approached by tailored programmes.

Keywords: Psychosis; Early detection; Prodrome; Outpatient health services; Program evaluation

To download the entire article, click here (PDF).

Posting of this abstract is for the purposes of research into early psychosis.

Also see:

Early Detection Fact Sheet (PDF)

Nova Scotia Early Psychosis Program

Photograph of Joachim Klosterkötter courtesy of the University of Cologne.