Severe problems

  1. Invest in early intervention.
  2. Develop primary care and mental health teams to collaboratively meet the needs of the local population
  3. Improve access to psychological interventions and family work.

Early intervention services for psychosis and bipolar disorder can reduce duration of untreated psychosis and, with sustained intervention, health and social care costs over the life-time of individuals – even with the most conservative estimates for effectiveness of interventions.

Specialist teams have been developed on the basis of evidence of their effectiveness in providing 24 hour access to services and alternatives to admission (Crisis resolution & home treatment) and engagement with people with severe problems (Assertive Outreach) alongside community mental health teams: reconfiguration to take account of local circumstances could provide improved access to evidence-based practice, social interventions and support whilst assertively engaging those with the most complex problems.

Psychological treatments are valued by those who receive them, have demonstrable effectiveness and, even with modest cost assumptions, appear to reduce high cost care in people with psychosis, bipolar disorder and severe emotional difficulties (‘borderline personality disorder’).