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Early intervention is a fundamental principle in health care and the past two decades have seen it belatedly introduced into the field of mental health. This began in psychotic disorders, arguably the least promising place to start. The steady accumulation of scientific evidence for early intervention has eventually overwhelmed the sceptics, transformed thinking in psychotic disorders and created an international wave of service reform. This paradigm shift has paved the way to a more substantial one: early intervention across the full diagnostic spectrum. 75% of mental illnesses emerge before the age of 25 years, and young people bear the major burden for those disorders that threaten the many decades of productive adult life. The paradox is that young people aged between 12 and 25 years have had by far the worst levels of access to mental health care across the whole lifespan. Health services are poorly designed, grossly under-resourced and typically unfriendly to, and untrusted by, young people. Furthermore, until recently there has been a quite striking lack of interest in this transitional age group from clinicians and researchers alike, who had unthinkingly accepted the paediatric-- adult split of mainstream medicine without questioning its utility and validity for our field and our young patients. Over the past decade, however, a major shift in momentum has occurred to take early intervention in youth mental health more seriously. Here we discuss the recent advances and evidence supporting an innovative integrated model of youth mental health care and look to the future. [ABSTRACT FROM AUTHOR]

Within the embryonic early psychosis field in the early 1990s, the conceptualisation and definition of an at-risk or ultra-high-risk (UHR) mental state for psychosis was a breakthrough which transformed the clinical and research landscape in psychiatry. Twenty-five years later, we have a new evidence base that has illuminated the neurobiology of the onset phase of psychotic disorder, delivered Cochrane level 1 evidence showing that the onset of fullthreshold sustained psychotic disorder can be at least delayed, and is paving the way to a new generation of transdiagnostic research. Here, we document the contribution of the UHR approach to understanding the underlying mechanisms of psychosis onset as well as the long-term outcomes. Particularly, we highlight that psychosis onset can be delayed in those meeting UHR criteria and that these criteria have a higher valence for subsequent psychotic disorders and some valence for persistent non-psychotic syndromes. Critiques have helped to identify some of the limitations of this paradigm, which are acknowledged. These include evidence that psychotic disorders can emerge more acutely and from other, as yet undefined, precursor states. Rather than defending, or alternatively questioning the value of, the UHR approach, we propose a broader, transdiagnostic staging model that is consistent with the pluripotent and variably comorbid trajectories for mental disorders. This approach moves beyond psychosis to capture a wider range of subthreshold symptoms and full-threshold disorders, thus enhancing prediction for the emergence and progression of a range of mental disorders, as well as providing new avenues for early intervention and prevention. [ABSTRACT FROM AUTHOR]

Mental Health First Aid (MHFA) is a potentially valuable first response in mental healthcare. MHFA is formulated as an extension of Psychological First Aid, the latter being a more focal response to crises and disasters. MHFA is a broader strategy which aims to improve the general public's immediate response to mental ill health and mental health crisis. While its effect on those trained in MHFA has been promising, recent metaanalyses have failed to detect any significant benefit to individuals who receive support from an MHFA trainee. Such outcomes highlight the need to revisit the content and implementation of MHFA to optimise and realise the full potential of the concept. Possible solutions are discussed, including developing new MHFA content using methodologies that foster innovation and creativity, in addition to improving the quality and effectiveness of MHFA training. [ABSTRACT FROM AUTHOR]