ABSTRACT
Over the past decade, there has been a growing sense of optimism about the prospects for better outcomes for schizophrenia and related psychoses, and this has achieved the status of a ‘progressive idea’. This has disturbed some (for example, Verdoux 2001) who have urged caution in proceeding with reform. However, while there is a sociopolitical dimension to all successful reform, this one has an increasingly solid basis in evidence. Clinicians and policymakers in particular are enthusiastic about reform based on this idea because of the sound logic behind it and the unacceptably poor access to and quality of care previously available to young people with early psychosis, and are encouraged by the increasing evidence that better outcomes can be achieved. The rationale for, and extent of, this reform is described in Edwards and McGorry (2002) and the latest evidence is reviewed in a balanced manner by Malla and Norman (2002). There has also been considerable resistance and scepticism which helps to keep the reform process ‘honest’. In this chapter I will summarise this evidence and provide guidelines for its clinical application.
