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There are many advantages in treating early.
The first is you could say it's damage control
because when mental illness is a for the first time usually an emerging adults.
It's a very sensitive period of life
because the young person is trying to establish their identity.
They're trying to develop a vocational pathway with education and work.
They're trying to separate from their family of origin and become independent humans.
And you know it's a very challenging set of tasks.
The brain is developing.
There's a whole lot of factors there that a lot more
risk taking behavior perhaps drugs and alcohol in the mix.
So, it's a very very sensitive time.
So, intervening early can prevent a lot of
the secondary damage that can occur from
delayed intervention which is really a social effect.
If you become mentally ill and it's not picked up and treated
effectively then you lose your friends, you lose your job,
you drop out of the education system and might not even finish
school and the family is put under major strain and you might
also get addicted to drugs or alcohol in the process so picking it up
early treating it effectively which we can do in
the majority of cases is very very important.
Well, the types of intervention that we see in a psychosis and
other early intervention programs and youth
mental health care are pretty needs based in the way.
So, depending on the level of need and complexity of the problem,
the interventions can be quite simple.
It can be just a matter of a listening ear, support,
reassurance, information and maybe some problem solving.
And ranging right through to- to more intensive bio psychosocial care involving
drug therapy more sophisticated psychological interventions
and a more extensive social support and even outreach.
So, it's a spectrum of care.
We use a staging model to actually work out you know what intensity to offer.
So if the person's in the early or mildest stages of a problem, obviously we respond,
you know, we don't over treat people,
we don't offer medications as the first line.
But if the problem is not responding to
those simpler interventions then we- we increase the dose and
the expertise that's made available and the medication
then might be a second or third stage offering for the person to choose.
And we have a lot of evidenced-based treatments in psychiatry.
And if they're delivered properly they can really
transform the outcomes for most patients,
not all patients we still have work to do for
some people who- who don't respond to what we already have to offer.
So that's a matter for research but in general we're very confident we can
change the course for the majority of patients.
Well if you think about early intervention it's best to turn the question around and say,
when would early intervention not be a good idea?
And I think there are two situations.
The first one is where you've got no effective treatments.
So there's no point, in a sense, of intervening early
because it doesn't change the prognosis for the patient.
You just intervene whenever you get the chance to.
The other situation is where the treatments that you have to
offer are likely to do more harm than good.
And obviously every every powerful treatment
especially drug therapies and more biological
treatments but also psychological treatments
they can have risks and harms associated with them.
So we were very careful in medicine and health care not to overtreat.
And the first principle is "do no harm" in medicine, goes right back to properties.
And so we have to balance the-
I suppose the ambition and
the proactiveness of treatment with that- with that sort of caveat.
But having said that in psychiatry,
we do have effective treatments and they do have risks.
So we've got to actually make the treatment proportional to
the seriousness and stage of the problem.
Early Intervention psychosis has been phenomenal
and actually in the last 20 years in psychiatry.
The treatment of psychotic illness is like schizophrenia were
completely clouded by pessimism and therapeutic nihilism,
certainly when I started psychiatry in the early- early to mid 80s.
That was the message every single patient that was diagnosed with schizophrenia
was told that the prognosis was very poor.
They probably wouldn't be able to work that and they wouldn't have a normal life.
Very hopeless message was given to the patients.
But since then we've- we've found
that if we do intervene early if we shorten the delays in treatment and
if we deliver evidence-based care in
a broad holistic way including
psychosocial interventions as well as drug therapies and we make
those consistently available that the outcomes
are much better and we have 20 years of evidence and
10 international meetings on this subject
to really strengthen the evidence-based in support of early intervention in psychosis.
The outcomes are definitely better after two years or so.
And the challenge then is maintaining those early benefits
over the longer term and that requires investment in
high quality mental health services to sustain those benefits
which sadly in many locations is not- not available to the public.
So there's a reform challenge here to make sure
this evidence is actually realised in the lives of ordinary people.
The other very exciting thing is that we've been able to go even earlier
prior to the first psychotic episode and find people who
are struggling and certainly impaired functionally and suffering but haven't
quite made the threshold for diagnosis for schizophrenia or other psychotic illnesses.
So this is called the prodromal or ultra high risk phase.
And there are 11 clinical trials showing now that we can actually
delay the onset of psychosis in this- in this at risk mental state as it presents.
So I think the frontier has moved,
you know, a long way forward.
And in the next decade we'll really refine this and it will
also extend the benefits of this approach to a whole range of diagnoses in young people.
With the youth mental health focus.
We've begun to extend the early intervention principle across the diagnostic spectrum
into- into other disorders and these disorders are not discrete illnesses per se.
There's a lot of overlap.
And the way they emerge in the first place is usually through
a mixture or constellation of different symptom patterns like depression, anxiety and
maybe some substance use some personality issues and then you might get
some warning signs of
the more classical psychiatric illnesses like schizophrenia appearing.
So this- this principle of early intervention that's been
pioneered in psychotic disorders is
now being applied in a more flexible way across the diagnostic spectrum.
The evidence is still early compared to the large body of evidence including
economic evidence in early intervention psychosis but
it's starting to be assembled in mood disorders,
in bipolar, depression, anxiety and eating disorders.
And the journal early intervention psychiatry has been founded to really support and
stimulate this sort of scientific research
to create the evidenced based across the diagnostic spectrum.
Early intervention and a fair deal for for people with mental illness,
especially young people in the prime of life because
75 % of these illnesses appear before 25.
This is not just a matter of
scientific research and evidence it's a matter of health care reform.
It's a matter of human rights.
It's a matter of a fair deal for people with
mental illness and that's 50 % of us at some point in our life.
So it's a matter of self-interest as well as
human rights and it's gonna take the whole community
and our political leaders and the whole society really to get behind this reform.
It's something that hasn't been possible until
this stage of human history because the mentally ill
have had a terrible legacy of suffering and neglect.
But we're starting to see some light at the end of the tunnel
here and it's been driven by science and evidence
but it will only really change if the society as a whole demands that some action occurs.