Can targeted early intervention improve functional recovery in psychosis? A historical control evaluation of the effectiveness of different models of early intervention service provision in Norfolk 1998-2007.
OBJECTIVE
This paper assesses the impact of different models of early intervention (EI) service provision on functional recovery and inpatient hospital admission. The study compares the outcome of a comprehensive EI team with a partial model (community mental health team (CMHT) plus specialist support) and traditional care (generic CMHT) over a 10-year period.


METHODS
The design is in comparison with historical control. The study compares the functional recovery outcomes of three cohorts from the same geographical area over the period 1998-2007. The primary outcomes were partial and full functional recovery defined with respect to readily identifiable UK benefit system thresholds and psychiatric inpatient admission days at 1 and 2 years post-referral.


RESULTS
Only 15% of individuals made a full or partial functional recovery at 2 years under the care of a traditional generic CMHT in 1998. In 2007, 52% of the cases were making a full or partial functional recovery under the care of the comprehensive EI team. A large reduction in inpatient admissions was associated with the EI strategy.


CONCLUSIONS
The implementation of comprehensive EI teams can have a major impact in improving functional recovery outcomes in psychosis and reducing inpatient admissions. Partial implementation using limited funding of specialist workers in collaboration with traditional care appeared to have a more limited effect on these recovery dimensions. The implementation of targeted EI in psychosis strategies can result in substantive functional benefits.
Early Intervention Service, Norfolk and Waveney Mental Health Foundation NHS Trust, Norwich, UK. d.fowler@uea.ac.uk
David
D
Fowler
Jo
J
Hodgekins
Lawrence
L
Howells
Melanie
M
Millward
Annabel
A
Ivins
Gavin
G
Taylor
Corinna
C
Hackmann
Katherine
K
Hill
Nick
N
Bishop
Iain
I
Macmillan
D000328:Adult; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data / Q000639:trends*; D061345:Early Medical Intervention / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000706:statistics & numerical data / Q000639:trends*; D011618:Psychotic Disorders / Q000628:therapy*; D011788:Quality of Life; D006113:United Kingdom