Clinical outcome of an early psychosis intervention program: evaluation in a real-world context

Objective: To examine whether staff training and service restructuring to provide specialized early psychosis services results in improved clinical outcomes for young people with first-episode psychosis. Method: Staff attended workshops on the treatment of early psychosis throughout 1997-2000 and specialized early psychosis teams began operating between 1998 and 2000 following service restructure. There was no additional funding provided for clinical services, but through the restructure, there was a shift in resources. During this period a comprehensive package including the Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms and the Health of the Nation Outcome Scale was introduced for clinicians to assess patients at intake, 3 months and 12 months into treatment. Symptom scores of patients treated earlier in the project are compared with those patients treated later, after more training and service developments had occurred. Results: Ninety-four of 215 potential first-episode patients consented to take part in the project. They provided data variously at intake, 3 months and 12 months into treatment. Regardless of the year of treatment, significant improvement in psychiatric symptomatology was found over the three assessment periods. Individuals who entered the service in the latter phase of the project experienced fewer negative symptoms (after 12 months of treatment) compared with patients who entered the service in the early phase of the project. Conclusions: Improvements in both pharmacological and possibly psychosocial treatment may have led to a greater improvement in negative symptoms. Benefits and limitations of conducting research in a 'real-world' context are discussed.