Services in France
Efforts are needed to destigmatize psychosis, so that patients are referred into services early in their disease course
Vincent Laprevote discussed the development of early detection and intervention (ED/EI) services in France. The target population is young patients who are experiencing an At Risk Mental State (ARMS) for psychosis, or a first episode of psychosis (FEP). Patients are admitted within 7 days and undergo rapid evaluation by a neuropsychologist, psychiatrist and case manager. There is intensive case management in the program that lasts 2–5 years. The care plan is based on therapeutic education (psycho-information), with cognitive behavioral therapy (CBT) and mindfulness for stress management, meta-cognitive training, and cognitive remediation and a substance-use program, as needed. A challenge within France is to ensure coherence in the developing ED/EI services, and that these fit with emerging international standards. Efforts are also needed to destigmatize psychosis, so that patients are referred into these services early in their disease course.
Targeting the right patients in Czech Republic
‘The sooner the better’ to contact early detection and intervention services
Ways of ensuring that patients are referred to these services were addressed by Petr Winkler of the Czech Republic. Project VIZDOM is a 4-year initiative running in the Czech Republic for early intervention in severe mental illness2. Early-detection strategies include targeting relevant stakeholders (health and social-care services, the educational system and authorities in the region), so they know the system is available and who will benefit. There is also a self-screening instrument available online that offers a low-threshold, low-stigma way to enter the system for patients. Finally, a leaflet on early detection has been made widely available – the key message is ‘the sooner the better’ to contact the services. As with other services, patients are rapidly evaluated after referral, and their outcomes assessed every 6 months.
Flexibility of service in Estonia
Involve patients’ families as early as possible in the treatment process
An EI system has been in place for 20 years in Estonia, as discussed by Karola Peebo. The core of this program is pharmacological and psychotherapeutic interventions. The multidisciplinary teams also involve patients’ families as early as possible in the treatment process. Rehabilitation includes support groups, vocational-based programs and the provision of specialized supported-living units. This service has a flexible duration of provision, based on individual needs. However, this means that the center has had to deal with an increasing number of cases over time. This can be managed by handing over case management from psychiatrists at the start of treatment to mental-health nurses and occupational therapists as patients spend longer in the system.