Welcome to the 22nd WCP Congress Program Scheduling

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Most patients with a first episode of psychosis respond well to antipsychotic treatment. However, improvements are typically not maintained and most patients experience multiple relapses over the course of illness. Evidence is mounting of a critical role for relapse events in the emergence of treatment failure, illness progression and brain morphological changes. The key to optima outcomes is intervening effectively as soon after the onset of the first psychotic episode as possible, and providing uninterrupted antipsychotic treatment over the first years, when the illness is at its most aggressive. Psychosocial interventions focussing on a person-centred approach and shared decision making, including family and carers, is associated with high rates of treatment acceptance. Offering long-acting injectable antipsychotics sooner rather than later is the best pharmacological intervention to provide continuous treatment.

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Recovery-orientation is widely endorsed as a guiding principle of mental health policy. Implementation warrants an understanding of the resulting new clinical and scientific responsibilities. Recovery-orientation brings new rules for services, e.g. user involvement and person-centred care, as well as new tools for clinical collaborations, e.g. shared decision making and psychiatric advance directives. Alternatives to conventional services, pertaining to e.g. acute crisis interventions and vocational rehabilitation need to be implemented in the context of scientific evidence as well as human rights obligations with regard to self-determination and social inclusion of persons with psychosocial disabilities. These developments are supported by anti-discrimination legislation and a call for participatory approaches. The collaboration between researchers with and without lived experience of mental health conditions is paramount for meeting the scientific responsibilities of recovery-orientation. Such collaborations have consequences with regard to research topics (e.g. user defined outcome measures), methods (e.g. mixed methods) as well as dissemination (fast and broad). New clinical responsibilities also entail the inclusion of the lived experience in service planning, delivery and quality assurance. Data show peer support is feasible and effective in different forms. Trialogue and other participatory approaches bring together major stakeholders in mental health, who share the responsibility for overcoming conceptual reductionism and unjustified prognostic negativism and strengthen rational and optimistic efforts towards recovery-orientation and system transformation.

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Background: The benefits of First Episode Psychosis (FEP) services may not be sustained after patients are transferred to regular care. Horyzons was designed as a comprehensive digital platform to address this issue. It merges: peer-to-peer social networking; theory-driven and evidence-informed therapeutic interventions targeting social functioning, vocational recovery and relapse prevention; expert clinician and vocational support; and peer support and moderation. The aim of the Horyzons project was to determine whether, following two years of specialized support for FEP, the addition of a digital intervention (Horyzons) to treatment as usual (TAU) for 18 months was more effective than TAU alone.

Methods: 170 FEP participants aged 16-27 were randomly assigned to Horyzons+TAU or TAU.

Results: 47.0% in the Horyzons group logged on for at least 9 months. Social functioning remained high and stable in both groups from baseline to 18-month follow-up, with no evidence of significant between-group differences. Participants in the Horyzons group had a 5.5 times greater increase in their odds to find employment/education compared with those in TAU (OR=5.55, p=0.04). Participants in TAU were twice as likely to visit emergency services (39% vs. 19%; p=0.03, NNT=5) and be admitted to hospital due to psychosis (13% vs. 27%; p=0.07, NNT=7) compared to those in the Horyzons group.

Conclusions: While we did not find a significant effect of Horyzons on social functioning, the intervention was effective in improving vocational attainment, a core component of social recovery, and in reducing usage of hospital emergency services, a key goal of FEP services.