Early intervention and recovery for young people with early psychosis: consensus statement1,*
J. BERTOLOTE, MD
World Health Organization
P. McGORRY, MD, PhD, FRCP, FRANZCP
International Early Psychosis Assocation
Correspondence:
Professor P. McGorry, ORYGEN Research Centre, Locked Bag 10/35, Poplar Road,
Parkville, Victoria 3052, Australia. Tel +61 3 9342 2921; fax +61 3 9342 2921;
e-mail:
mcgorry{at}ariel.unimelb.edu.au
1 This document is based on the UK Newcastle Declaration (2002), an idea
conceived by IRIS, the Initiative to Reduce the Impact of Schizophrenia, and
further developed with the support of Rethink and the National Institute for
Mental Health in England. 
* Paper presented at the Third International Early Psychosis Conference,
Copenhagen, Denmark, September 2002. 
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ABSTRACT
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International declarations that articulate core values, goals and standards
have played an important role in enhancing the quality of care in a number of
areas of medicine.This document attempts this task for early intervention in
psychotic disorders.It was originally inspired by the St Vincents declaration
on the care of diabetes and carefully developed by David Shiers and Jo Smith
with support from the Initiative to Reduce the Impact of Schizophrenia,
National Institute for Mental Health in England and Rethink, resulting in the
UK-focused Newcastle Declaration. The World Health Organization and the
International Early Psychosis Association then collaborated to produce an
international version of the declaration, which articulates the universal
principles of early intervention and tries to blend these with local
capacities and cultural diversity.
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INTRODUCTION
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According to the World Health Organizations
World Health Report
2001 (World Health
Organization, 2002), schizophrenia and other forms of psychoses
that affect young people represent a major public health problem. Worldwide,
they rank as the third most disabling condition (following quadriplegia and
dementia and higher than blindness and paraplegia) and pose an enormous
burden, both in terms of economic cost and of human suffering.
Yet, despite the availability of interventions that can reduce relapses by
more than 50%, not all affected individuals have access to them, and when they
do, it is not always in a timely and sustained way. Among the goals of care to
these people, the identification of the illness and its treatment, as early as
possible, represents a high priority.
Comprehensive programmes for the detection and treatment of early psychosis
and in supporting the needs of young people with early psychosis carry the
important function of promoting recovery, independence, equity and
self-sufficiency and of facilitating the uptake of social, educational and
employment opportunities. These programmes can be provided by individuals and
teams with specialised skills, with a full range of primary healthcare
services for every young person with early psychosis.
Prompt and effective interventions for young people with early psychosis,
for their families, close friends and other carers represent a major element
of respect of individuals rights to citizenship and social
inclusion.
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VISION
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Fundamental objectives derived from this statement are to:
- Challenge stigmatising and discriminatory attitudes so that young people
are not disadvantaged by their experiences and are truly included in their
local communities.
- Generate optimism and expectations of positive outcomes and recovery so
that all young people with psychosis and their families achieve ordinary
lives.
- Raise wider societal awareness about psychosis and the importance of early
intervention.
- Attract and encourage practitioners from a wide range of health, social,
non-governmental agencies (e.g. charitable, voluntary and youth), educational
and employment services to reflect on how they can better contribute to
supporting young people with psychosis, their families and their friends.
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VALUES
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Programmes for the detection and treatment of early psychosis should
value:
- Respect of the right to recovery and social inclusion and support for the
importance of personal, social, educational and employment outcomes.
- Respect of the strengths and qualities of young people with a psychosis,
their families and communities, encouraging ordinary lives and
expectations.
- Services that actively partner young people, their families and friends to
place them at the centre of care and service delivery, at the same time
sensitive to age, phase of illness, gender, sexuality and cultural
background.
- Use of cost-effective interventions.
- Respect of the right for family and friends to participate and feel fully
involved.
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A 5-YEAR PROGRAMME OF ACTION
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This consensus statement describes
(Table 1) a number of 5-year
measurable outcomes that an individual and their family can expect from
services who have successfully implemented a comprehensive and effective
programme.
View this table:
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Table 1 Five-year outcomes that a comprehensive and effective programme would
deliver to people with early psychosis and their families
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TECHNICAL INTERVENTIONS
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Attaining these 5-year outcomes will require underpinning by modern
technical interventions and actions:
- A series of interventions has demonstrated efficacy in the management of
early psychoses, among which there are pharmacological and psychosocial
approaches, the latter addressed to both patients and family members
(International Early Psychosis Association
IEPA consensus statement, 2002).
- Some of these interventions are specified, by level of resources in a given
area, in Table 2, according to
the recommendation put forward by the World Health Organizations
World Health Report
2001. In the same Annex are found strategic actions
needed/useful for the implementation of those interventions.
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REFERENCES
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Consensus Statement on Principles and Practice in Early
Psychosis (2002) In Implementing Early
Intervention in Psychosis: A Guide to Establishing Early Psychosis
Services (eds J. Edwards & P.D.McGorry), pp. 145
155. London: Dunitz.
The Newcastle Early Psychosis Declaration (2002)
http://www.rethink.org/newcastledeclaration
World Health Organization (2002)
World Health Report 2001. Mental Health: New Understanding. New
Hope.Geneva: WHO.
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