title: Early intervention services in psychosis: from evidence to wide implementation.
abstract: Early intervention (EI) in psychosis is a comprehensive and evidence-based approach aimed at detection and treatment of psychotic symptoms in their early stages. This paper presents core features and noteworthy aspects of the evidence basis and limitations of EI, the importance of programme fidelity, challenges for its widespread dissemination and economic perspectives related to it.
  
  
  
  This paper is a narrative review about the evidence supporting EI and the challenges to its widespread dissemination.
  
  
  
  In spite of evidence of a wide range of benefits, widespread dissemination has been slow, and even currently implemented programmes might be threatened. This reflects in part the shortcomings of mental health care in general, such as low priority for funding, stigma and structural problems. Successful examples of advocacy, mobilization and destigmatization campaigns have overcome these difficulties.
  
  
  
  Funding for mental health in general and for EI services appears low relative to need. One key argument for better funding for EI can be found in its favourable cost-effectiveness, but not all stakeholders beyond mental health administrators are aware of this. Positive impacts of EI programmes on excess unemployment and tax forgone suggest that social affairs and labour ministries - and not only health ministries - could be more involved in governance of mental health issues; ministries of justice and education are other sector stakeholders than can benefit. Wider dissemination of EI services will probably benefit from better integration of potential funders, promotion of joint targets and shared financial or budgetary incentives.
authors.affiliation: Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark. claudio.csillag@regionh.dk.
authors.forename: Claudio
authors.initials: C
authors.lastname: Csillag
authors.affiliation: Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Merete
authors.initials: M
authors.lastname: Nordentoft
authors.affiliation: Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Mizuno
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, UK.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Eóin
authors.identifier: 0000-0001-9649-5551
authors.initials: E
authors.lastname: Killackey
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Matthew
authors.identifier: 0000-0003-4716-4662
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Department of Psychiatry, University of Hong Kong, Hong Kong.
authors.forename: Eric
authors.initials: E
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York, USA.
authors.forename: John
authors.initials: J
authors.lastname: Kane
authors.affiliation: Health and Social Care, London School of Economics and Political Science, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: McDaid
mesh_terms: D003362:Cost-Benefit Analysis; D061345:Early Medical Intervention / Q000191:economics / Q000379:methods*; D006295:Health Resources / Q000191:economics; D006297:Health Services Accessibility; D006801:Humans; D011618:Psychotic Disorders / Q000628:therapy*
keywords: early intervention in psychosis; evidence-based medicine; health planning; implementation; psychiatric service