Evolution of early psychosis intervention services in Singapore.

The alarmingly long duration of untreated psychosis in Singapore and probable severe consequences were the impetus for establishing the Early Psychosis Intervention Programme in 2001. In 2007, the Early Psychosis Intervention Programme became a part of the National Mental Health Blueprint. This study analysed the Early Psychosis Intervention Programme's key outcomes according to the case management model, and shows how the programme has evolved and expanded into indicated prevention by establishment of the Support for Wellness Achievement Programme focusing on at-risk mental state. The Early Psychosis Intervention Programme has incorporated an evaluation component into the clinical programme by administering regular structured assessments and generating operational statistics from the hospital's data systems. Based on data analysis from a study on consecutive patients accepted into the Early Psychosis Intervention Programme over a 4-year period, we found that at the end of 2 years of follow-up, majority of patients (85%) scored ≥ 61 on Global Assessment of Functioning (GAF) disability scale, while two-thirds (66%) met criteria for functional remission, which was defined as having a GAF disability score of ≥ 61 with engagement in age-appropriate vocation (gainfully employed or studying). There was also a significant decrease in the Positive and Negative Syndrome Scale for schizophrenia (t = 27.7, p < 0.05) and increase in GAF (t = 33.7, p < 0.05) mean scores from baseline at 2 years. As a national programme, the Early Psychosis Intervention Programme has articulated processes and outcome indicators to the stakeholders, and a periodic report card on these outcomes ensures accountability to the funders, patients, and their families.