Abstract
Background: A series of national engagements between experts and community members with lived experience of Early Psychosis Intervention (EPI) was undertaken to understand the unique client-centred areas of consideration for developing national standards for EPI services. Community InvolvementThis project was a collaborative effort between experts (health care providers, policymakers, researchers, care teams, and academics) and persons with lived and living experience of early psychosis as well as their designated support persons (family, caregivers, friends).
Approach: The National Workshop Agreement (NWA) aimed to develop a document initiating the consensus process for a National Standard of Canada (NSC). This involved engaging diverse knowledge-holders across Canada to understand consensus areas and unknowns, influencing future standard-based deliverables relevant to Early Psychosis Intervention (EPI) services. The process advanced best practices by collaborating with people with lived experience to expand upon existing research. There were a series of engagements co-designed with community members which established facilitated discussions about considerations for EPI services with the focus of developing recommendations for standard development. Over 278 individuals from 0 provinces/territories participated in engagements, including 65 self-identifying as persons from equity-deserving groups. A Working Group chaired by CAMH and Health Standards Organization (HSO) involved individuals with lived experience and caregivers, in co-designing bilingual engagements to prioritize high-quality, accessible, and timely EPI. Engagements included a national survey, workshops in Montreal and Toronto, a virtual workshop, and an Indigenous-led focus group. All participants contributed and reviewed the final report (National Workshop Agreement for EPI) to ensure the findings and recommendations were an accurate reflection of their diverse perspectives. The results were submitted to the Standards Council of Canada, recommending the development of a national standard for EPI.
Results: The Workshop Agreement provided recommendations covering: System design: Policy and system-level considerations for accessible, evidence-based mental health systems. Program delivery: Timely, culturally appropriate, equitable, person-centered, team-based, and effective EPI care. Implementation: Actionable, measurable, and continuous-improvement-focused services within a Learning Health System. In addition, the following themes were generated by the community: Prioritizing Indigenous-led research and service design. Improving awareness and timely access to EPI programs. Providing holistic care for clients and support persons. Integrating EPI with substance use health services. Offering developmentally appropriate, strengths-based care. Designing culturally safe, stigma-free, and anti-racist care.
Implications: EPI's holistic, strengths-based approach considers overall well-being, social integration, and quality of life. Research and community feedback shows EPI leads to faster psychiatric care, lower emergency department use, and reduced mortality, with improved symptoms, reduced relapse rates, and enhanced social functioning. EPI also has significant economic implications, preventing long-term disability and reducing healthcare resource needs. Early intervention helps individuals maintain employment, education, and social functioning, reducing economic dependence on healthcare and social support services. The recommendations emphasize the quality of life, service delivery efficacy, and economic benefits of a national EPI standard. While currently provincial and territorial governments design, implement, and maintain healthcare infrastructure, leading to varied EPI standards, this project reinforces the benefits of a cohesive nationwide approach to EPI. The Workshop Agreement outlines criteria for this standard and recommends further steps developed with community input to ensure policies are client-centred. The Standards Council of Canada and Health Canada are reviewing the report alongside a larger mental health standards roadmap to determine policy development priorities. Continued community involvement is expected in developing and prioritizing EPI standards across Canada.