In recent years there have been calls for a paradigm shift in psychiatry from treating established illnesses towards early and preventive intervention (McGorry & Killackey, 2002). These calls have been associated with the development and proliferation of services providing early and preventive intervention for psychosis (Lester et al. 2009). However, it is often not appreciated that this is not a new approach: it was proposed at least 100 years ago (Maudsley, 1909). In his paper published in 1909 Maudsley outlined the need for psychiatric services to focus on treating people early in their illnesses because this is when he thought there was the best chance of recovery and cure, stating: ‘the right treatment is to stop the beginnings of mischief’ and ‘early treatment … will prevent the necessity … of placing some patients in a lunatic asylum’ (Maudsley, 1909). In the last 100 years considerable evidence has accrued indicating that he was right – early and preventive intervention is associated with better outcomes and reduced admission rates (for review see McGorry, 2005). However, there appears to be a gap in translation: many health services have implemented cheaper hybrid and hub-and-spoke models rather than the comprehensive stand-alone early intervention team structures evaluated in the evidence base (Lester et al. 2009). The study by Valmaggia et al. (2009) is striking in providing evidence that better outcomes can also be cost effective. We hope that health-care commissioners take note that this was achieved with a comprehensive stand-alone team (Valmaggia et al. 2009). Other team structures may not be as effective – a cheaper service may cost more in the long run. Hopefully it will not take another 100 years for the funding to follow the evidence.
Declaration of Interest
Dr Howes works in the OASIS service providing preventive intervention for people at clinical risk of psychosis.