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Early Interv Psychiatry. 2018 Dec;12(6):1222-1228. doi: 10.1111/eip.12564. Epub 2018 Mar 26.

Description, evaluation and scale-up potential of a model for rapid access to early intervention for psychosis.

MacDonald K1,2,3, Malla A1,2,3, Joober R1,2,3, Shah JL1,2,3, Goldberg K4, Abadi S4, Doyle M5, Iyer SN1,2,3.

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Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada.
ACCESS Open Minds (Pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.
Douglas Mental Health University Institute, Montreal, Quebec, Canada.
Concordia University, Montreal, Quebec, Canada.



This paper aims to describe the entry protocol of the Prevention and Early Intervention for Psychosis Program (PEPP)-Montreal, an early intervention program for psychosis. The protocol is designed to fulfil a key objective of the early intervention movement-reducing delays to accessing high-quality care. The paper also aims to describe how this rapid entry protocol can be deployed in other services interested in reducing delays in initiating treatment.


PEPP provides rapid, easy access to quality care by placing a single, well-trained professional, the intake clinician, at the point of entry. Anyone can refer a youth directly and without formalities to the intake clinician who responds promptly and sensitively to all help-seeking, whether by a youth, a family member, a school counsellor or anyone acting on behalf of a youth in need. To promote accessibility, PEPP guarantees an initial assessment within 72 hours; maintains relationships with referral sources; and conducts awareness-enhancing outreach activities.


Since 2003, PEPP has received 1750 referrals, which have all been responded to within 72 hours. Families have been involved in the intake process in 60% of the cases and hospitalization may have been averted in over half of the referrals originating from emergency-room services. Another indicator of success is the very low turnover in the intake clinician's position. Overall, the PEPP model has succeeded in providing rapid, engaging, easy and youth-friendly access to high-quality care.


The success of this protocol at PEPP has inspired the entry protocols at other first-episode psychosis services. Its ability to provide rapid, engaging access to high-quality services may allow this protocol to become a model for other early intervention services for psychosis and other mental illnesses.


early intervention; first-episode psychosis; health services accessibility; intake; treatment delays


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