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Where is the evidence for incorporating early intervention treatment into the CMHT?

Published online by Cambridge University Press:  02 January 2018

Ahmed Samei Huda*
Affiliation:
Tameside and Glossop Early Intervention Team/South Sector CMHT, Pennine Care NHS Foundation Trust, Dukinfield, UK, email: ahmed.huda@nhs.net
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Abstract

Type
Columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2014

Although it is gratifying to be regarded as the ‘best of the staff’ by someone as esteemed as Professor Peter Tyrer, I take issue with the suggestion that early intervention teams (EITs) should be broken up and their functions incorporated within a flexible community mental health team (CMHT). Reference Tyrer1 Following the principle of ‘Let Wisdom Guide’, one would like to see the evidence before taking such a step. For while it may be true that assertive outreach teams and other innovations in Britain proved disappointing for some of the reasons outlined in the article, this is not the case for early intervention. For example, there is evidence that EITs reduce hospital admission compared with CMHTs Reference Gafoor, Nitsch, McCrone, Craig, Garety and Power2 and that once patients are transferred back to CMHTs, the admission rate goes up again. Reference McCrone, Craig, Power and Garety3

If we have a service model of proven effectiveness, particularly in reducing demand on the most expensive elements of mental healthcare (in-patient beds), such as EITs, why switch to an unproven service model? One can make a tentative case that the superior outcomes are due to ‘better skilled’ EITstaff or to the extra resources these teams have – which the McCrone paper shows pays for itself by reducing demand Reference McCrone, Craig, Power and Garety3 – but a wise approach suggests waiting for evidence of effectiveness of these CMHTs with EIT functionality before ploughing ahead and dismantling an evidence-based superior service.

Footnotes

Declaration of interest

A.S.H. is a consultant in an early intervention team.

References

1 Tyrer, P. A solution to the ossification of community psychiatry. Psychiatrist 2013; 37: 336–9.Google Scholar
2 Gafoor, R, Nitsch, D, McCrone, P, Craig, TKJ, Garety, PA, Power, P, et al. Effect of early intervention on 5-year outcome in non-affective psychosis. Br J Psychiatry 2010; 196: 372–6.Google Scholar
3 McCrone, P, Craig, TKJ, Power, P, Garety, PA. Cost-effectiveness of an early intervention service for people with psychosis. Br J Psychiatry 2010; 196: 377–82.Google Scholar
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