SMILE: a service for prevention, monitoring and early intervention in psychiatry

Objective In the present report, we describe the organization of our multidisciplinary mental health primary care intervention for youths with psychiatric problems and we report preliminary evidence of its effectiveness. Methods Our service has been named SMILE, the acronym of "Servizio di Monitoraggio e Intervento precoce per le Lotta agli Esordi della sofferenza mentale e psicologica nei giovani". It has been established within the Psychiatric Unit of the University of L'Aquila. Aim of the service is to allow systematic evaluation, recognition and integrated treatment (psychological, psychosocial and psychopharmacological) of early mental and psychological problems in young people, to prevent psychological discomfort and mental illness, to warrant continuity of care in all phases of discomfort and to recognise and offer care for mental disorders at onset. Other missions of our service include early recognition of the pre-psychotic prodromal stage and the psychotic pre-phase, in order to permit the identification of the largest possible proportion of at-risk individuals, as early as possible, and their referral to appropriate treatment. Furthermore, we provide medical psychiatric residents with training to recognise and treat pre- morbid, prodromic and early signs and symptoms of psychiatric problems and mental disorders. Results One hundred seventy-four patients (80.5%) were admitted more than once, for a total of 685 admissions. Two hundred ninety-eight admissions (61.5%) were for cognitive-behavioural therapy care, one hundred nineteen admissions (25,5%) were for psychosocial integrated treatment care while 77 admissions (15,9%) were only for pharmacological treatment care and active treatment check. We divided in five macro-area diagnostic hypothesis sub-groups the different clinical dimension observed, also considering the non-clinical needs (Psychological discomfort/derangement Macro-area; Anxiety Macro-area; At risk mental state Macro-area; Mood Macro-area; Psychosis Macro-area). The most frequent symptoms detected were anxiety, depression, sleep disorders, eating disorders, trouble with thinking and concentration, reduced drive and motivation, loss of energy, social withdrawal, school and/or work problems, conduct problems/ hypo manic behaviour, psychosomatic problems. Conclusions The SMILE service has been established a comprehensive early intervention service providing most of the mental health service requirements for young people, across a broad range of mental suffering states and overt psychiatric symptoms. Notably, it is a significant advance over what was provided before in Italy. Hopefully, the development of early intervention programs for mental suffering will result in better linkages between child and adult psychiatry services and also with those long-term care to ensure treatment of psychiatric disorders throughout the life cycle.