Early Psychosis Intervention (EPI) is an evidenced-based specialized approach to providing services to individuals affected by first episode psychosis. It is aimed at early recognition of psychosis, the provision of timely comprehensive treatments that are stage and age-appropriate, family/caregiver inclusive and with a client-centred strengths-based approach.
The concepts of EPI began with research findings in multiple countries in the 1990s prompting the development of care systems to intervene early in the course of psychotic disorders. This early intervention approach challenged pessimism and reformed aspects of mental health in many countries around the world, within Canada and here in BC.
Service provision standards and best practices continue to expand as a result of ongoing research outcomes from around the world.
EPI strives to recognize psychosis as early
‘Early’ refers to identifying and providing services to young people and their families/caregivers as soon as possible, at the first appearance of psychotic symptoms.
Duration of untreated psychosis (DUP) refers to the time from when acute symptoms of psychosis first appear, to the time when effective treatment is received. There is strong evidence that a shorter DUP is associated with better outcomes. This early detection is accomplished through:
- Active ‘case finding’ (seeking people who may be just beginning to experience psychosis)
- Extensive community education, engagement with ‘gatekeepers’ (e.g., schools, parents/caregivers and anyone who work with youth)
- A low barrier, accessible referral process with a timely response.
EPI includes a holistic, research and evidence-based approach
Psychosis tends to emerge during the mid-to-late teenage years and early twenties – an important developmental stage for young people in terms of their identity, independence, relationships, educational and long-term vocational plans.
A key rationale for early intervention in psychosis is to limit disruptions to the young person’s important developmental stages, in addition, to reduce distress and suffering the symptoms that can cause the young person and those close to them.
Evidence-based EPI interventions not only achieve symptomatic recovery, but also functional recovery. Symptomatic refers to symptoms of psychosis and functional recovery refers to such things as a return to school or work, family and other social relationships, having a place to live, and addressing physical health needs.
Key evidence-based interventions and supports include:
- Client and family/caregiver-centred approach that includes the strength-based model.
- Assistance to return to school or pursue work as soon as possible.
- Reduce secondary symptoms such as anxiety, depression, substance misuse or risk of suicide.
- Provide family, caregivers and loved one’s education about psychosis and treatment to promote a team approach to care.
- Family therapy to support and maintain healthy family/caregiver relationships.
- Provide age and phase-appropriate interventions.
- Age-appropriate – the creation of a youth-oriented culture of services that emphasizes engagement with young people and recognition of their individual needs.
- Phase appropriate- A person usually goes through phases of a disorder. At first, the symptoms are intense and therefore should receive plenty of contact and support from service providers.
If a person’s symptoms are not well controlled after trying several different antipsychotic medications, they may be in a slow recovering phase and should receive pharmaceutical evidence-based treatment pathway in accordance with their symptom presentation.