Early Psychosis Intervention in an Asian Context: a decade of Real-life developments and outcomes in Hong Kong

Abstract

Early Intervention Programs worldwide are guided by a set of common frameworks. They include early detection through reduction of duration of untreated psychosis, provision of phase specific intervention to optimise outcomes in the critical period, as well as prevention before full-blown psychosis. Early psychosis programs worldwide implement these objectives in diverse real-life cultural and service settings. The interaction between ideas and implementation shaped the eventual form and outcome of services. It is important to be aware of how some of these factors interact and crucially impact upon service outcome. Insight can be gained with a review of the development of the early intervention program in Hong Kong. The program initially developed in a low-resource, high-stigma setting similar to many Asian locations. Specific contexts included reliance on inpatient services, crowded outpatient services, and high stigma. In tackling these challenges, unique Public awareness efforts were aligned with improved access to specialised services. Specialised intervention teams with case management were introduced. Cohort comparisons suggest that intervention improved aspects of outcome such as mortality, hospitalisation and functioning. Controlled study demonstrates that benefits can be obtained by intervention extended into the third year after psychosis onset. Long-term follow-up studies suggest that some of these benefits may still be discernible many years later. Nevertheless some areas (such as relapse rates) have not shown clear benefit. Further improvements are expected with ongoing developments of the program.