It sounds rather fantastic – but so is RAISE (Recovery After an Initial Schizophrenia Episode) - a US National Institute of Mental Health (NIMH) research project that seeks to fundamentally change the trajectory and prognosis of schizophrenia through coordinated and aggressive treatment in the earliest stages of illness.

Dr Mary Brunette,* Associate Professor of Psychiatry at Dartmouth Medical School and the Medical Director of the Bureau of Behavioral Health within the New Hampshire Department of Health and Human Services, chaired a session of five presentations describing just some of the work of RAISE and its intervention programme ‘Navigate’.

Dr Brunette explained that the concept behind RAISE is that with early and appropriate intervention from the very first episode of psychosis, it should be possible to reduce the likelihood of long-term disability in schizophrenia and help patients lead more productive, independent lives.

‘Navigate’ has 4 components – 1) ensuring patients receive tailored medication designed to their needs, 2) providing resilience training for young people still processing the ideas around their disease and its treatment, 3) supporting employment, education and rehabilitation of first-episode patients and 4) engaging with and supporting families.

Promising mixture

In a study comparing patient outcomes at community health centres that had been trained using the tools and methods of ‘Navigate’ with outcomes at centres using usual care practices when managing first-episode patients – the benefits of coordinated speciality care were evident. First episode patients had a reduction in overall symptoms (and in positive and negative symptoms), stayed on treatment longer, had better engagement with their doctors and carers, and an improved quality of life. Dr Brunette said that the patients in this study – drawn from all corners of the US – had a median duration of untreated disease of 74 weeks at study entry – with almost 70% having gone untreated for more than 6 months.

On track

She said that a key goal needs to be shorten that window and expedite pathways to care at community level – something that needs better public health awareness. Getting young people back on track with work and education is another aim of early intervention and one that needs payers to realise that ‘rehabilitation’ can be preventive and is a worthwhile investment in first-episode patients.

Family focus

In this study, 77% of patients were living with a relative. Dr Shirley Glynn of UCLS reminded delegates that it is quite common for relatives to be wracked with guilt and stigma and believe that treatment s are harmful. She said such attitudes can corrode any treatment plans. Consequently, the family support aspects of the coordinated care programme of RAISE ensure that relatives were helped to believe in the need for treatment.

Cost of the menu

Training healthcare staff and supporting families are services that have a cost. But the good news from RAISE and Navigate is that the entire package of coordinated speciality care appears to be a cost-effective intervention. According to Robert Rosenheck, Professor of Psychiatry and of Public Health (Health Policy) at Yale, this early intervention and care programme is associated with incremental cost ratios (ICERs) that compare favourably with those for many other therapeutic interventions in different fields of medicine. Importantly, patients enjoyed improved quality of life from the programme.

Prof Rosenheck pointed out that patients were offered the option of receiving long-acting injectable therapy for first episode psychosis. He also showed data from his cost effectiveness analyses which suggests the earlier patients are treated the better. Those with the shortest duration of untreated psychosis had the greatest improvements in quality of life for a more cost effective intervention.

So for patients, families and keepers of the purse – its seems early action, early treatment, psychotherapy and support can make a winning combination.

* Dr Mary Brunette** chaired a 3-hour symposium called “Implementation of coordinated speciality care for first-episode psychosis in US community mental health clinics”