Early intervention services for psychosis in the metaphorical ‘trenches’ of contemporary care: already known from the real trenches of WW1?

Evidence for the effectiveness of early intervention services (EIS) for first episode psychosis (FEP) has recently been documented in an exhaustive meta-analysis and meta-regression across 13 indices of outcome in 10 randomised clinical trials (Correll et al., 2018), supplemented by subsequent evidence for reduction in risk for suicide (Chan et al., 2018). Additionally, we have recently reported reduction in health economic costs using the net benefit approach (Behan et al., 2019). But what are the origins of this model of care? While the studies included in the above meta-analysis and meta-regression were published between 2004 and 2016, perhaps the first systematic proposal that increasing duration of untreated psychosis (DUP; see Clarke et al., 2016) was associated with poorer long-term outcome, and hence that early treatment could improve outcome, may be credited to Wyatt (1991). However, though articulations of the potential of early intervention for psychosis can be found as far back as the 1920s (Sullivan, 1927), initial systematic reports on the value of EIS can be found a decade earlier, followed by generations of neglect before ‘rediscovery’.