Welcome to the EPA 2022 Interactive Programme 

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The implementation of early intervention services (EIS) dedicated to first episode psychosis (FEP) remains a challenge in France. In 2016, the London School of Economics published a report in which France appeared as a poorly developed country in terms of early intervention services. Since the 1980s, the French psychiatric “sectorization” system offers access to general psychiatric care with a graduated intensity (outpatient consultations, day hospitalization, full time hospitalization) targeting territories (“sectors”) of approximately 70,000 inhabitants. While this system has advantages in terms of universal access to care, it leaves little room for specialized services. The Greater Lyon agglomeration (2.4 million inhabitants) is composed of several psychiatric sectors administered by 3 psychiatric hospitals and a psychiatric emergency system administered by a University Hospital. Since 2018, various hospital and university stakeholders, patient associations and international partners, have been working together to tailor, set up and organize a care system for FEP patients. We present here how we have federated workforce resources initially working within 11 general psychiatric “sectors” and covering a population of 850,000 inhabitants. A 3-step process of (1) field analysis, (2) the creation of a community of practice composed of healthcare workers, researchers and service users, and (3) confrontation of the already existing healthcare with the logic of “principal components” for FEP care, allowed the creation of the outpatient “PEPS” service, which now offers continuous case management, a functional recovery program and new pathways to care to more than 200 patients with a diagnosis of first episode psychosis.

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During the ongoing COVID-19 pandemic, two regions in Croatia, Zagreb and Petrinja in the Sisak-Moslavina County experienced strong earthquakes, on the March 22^nd 2020 and on the 29th of December 2020. Both earthquakes, but especially the later one resulted on severe damage of the regions and caused severe disruptions in (mental) health service delivery. In these circumstances, the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE), which was ongoing in Croatia from 2018-2022 aimed to implement flexible assertive community treatment as the new health care service for persons with severe mental illness (SMI). Since the pandemic and earthquakes have significantly influenced the life circumstances of all RECOVER-E project participants with SMI, we wanted further to examine the impact of health care delivery on mental health and the response to stress caused by a pandemic and earthquake in the patients with SMI involved in the project, in the first and second wave of the COVID-19 pandemics. Additionally, using case series, we will demonstrate the community mental health teams’ contributions in managing SMI after a double disaster in providing feasible, comprehensive, and accessible mental health services.

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The approach of a multi-professional team in the treatment of acute psychosis was started in 2018/2019 In Latvia, within the framework of the early intervention program. Until then, the patient was mostly examined and treated with medication in the inpatient phase of acute psychosis. After discharge, further treatment and rehabilitation in Latvia is still relatively limited and largely based on the initiative of the patient and relatives.

Within the multi-professional team of the inpatient department of the Riga Psychiatry and Narcology Center, a psychiatrist, mental health nurses, nursing assistants, psychologists, occupational therapists, a physiotherapist, a visual arts and dance - movement therapist, as well as a social worker work together . The benefits of teamwork in the treatment of acute psychosis are undeniable, but during these few years, working in challenging conditions, various disadvantages have crystallized.

Among the 'pros' is a more successful, multifaceted outcome of recovery, better patient compliance and reduction of stigma among patients and their relatives (and thus in society as a whole).

'Cons' are mainly due to limited availability of resources, from limited funding and infrastructure to a lack of professionals and time. It should also be noted that mental health literacy is still low in Latvian society, which means that patients often arrive late for help, which means that it is not possible to achieve good results in a limited time within the hospital. For these reasons, treatment is often discontinued after discharge, which increases the risk of rehospitalisation and adverse course of the disease.