Specialised care for early psychosis

Editor—Craig et al tried to evaluate early intervention services for psychosis empirically.¹ The results of the Lambeth Early Onset (LEO) trial may, however, be misrepresented, especially by those who think that early intervention services are a waste of valuable resources,² and be used to argue that resources should be directed to inadequately resourced routine services, the supposed comparison group in the LEO trial.

The comparison in the LEO trial was not between a well funded specialist team and run down inner city services, but between a newly formed specialist team that was learning on the job and between well established and integrated community mental health teams. A randomised controlled trial of a developing team at its inception is the equivalent of conducting a clinical trial on a drug without first establishing its pharmacokinetic and pharmacodynamic properties.

ETHOS, the neighbouring early intervention service in southwest London, was set up in July 2001. The ETHOS team has taken three years to determine the key ingredients of effective biological and psychosocial interventions for its patients, the appropriate generic and specialist skill mix of the team, the duration of service provision, pathways into and out of care, and strategies for preventing relapse.

Despite all the problems entailed in developing and establishing a new service, the LEO trial shows some positive outcomes for patients receiving early intervention. It would be unfortunate therefore if the limited effectiveness of LEO intervention simply strengthens the prejudices of the nay-sayers and confirms the principle of dangerous precedent: nothing should ever be done for the first time.