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Counting the cost: Commentary on a systematic review of cost of early intervention in psychosis

Australian & New Zealand Journal of Psychiatry, 46(8) clinical programmes. Questions such as what are the needs of our clients, what services are we providing, to how many are we providing these services, what are their impacts and how well are we meeting our clients’ objectives are fundamental. Surely professionals cannot doubt the importance of collecting information relevant to each of these issues. When such information is collected and examined, they almost inevitably lead to the question, ‘How can we do better?’. In that context, the motive for careful analysis and evidence-based change becomes intrinsic for service programs as opposed to being seen as an imposition from outside (Hodges, 2011; Rush and Ogborne, 1991). In addition to the need for more accountability for the effectiveness of clinical and social services; we have to recognize their limitations, particularly when addressing issues related to social circumstances and exclusion such as employment and accommodation. Consistent with the observations of Carr et al., (2012) the many forms of social exclusion are likely to be significant contributors to the dysphoria, anxiety and reduced self-esteem that accompany psychotic disorders (Birchwood et al., 2007; Davidson et al., 2001). Developing and evaluating interventions for individuals with psychotic disorders designed to reduce the impact of community-based exclusion are important, but social interventions to reduce the likelihood of such exclusion are also important and challenging (Corrigan, 2012).