Implementing an early psychosis prevention service in the basque country: Ten lessons from the PREGAP experience

Background and objectives Early intervention in psychosis has become a major priority in mental health care, supported by evidence that reducing the duration of untreated psychosis improves long-term outcomes. However, despite growing interest in clinical high-risk states for psychosis (CHR-P), structured preventive services remain scarce in many public healthcare systems, including Spain. The PREGAP programme was developed in the Basque Country as a specialised early intervention service for young people at CHR-P and with first-episode psychosis (FEP). This work aims to synthesise practical lessons derived from its early implementation to inform the development of similar services in other settings. Methods This article follows a narrative and practice-oriented approach grounded in the real-world implementation of the PREGAP programme. The ten lessons were derived through an iterative process combining clinical observations, analysis of organisational challenges and referral pathways, multidisciplinary team discussions, and feedback from individuals with lived experience participating in the “Elkar Entzun” initiative. Results Ten interrelated lessons were identified, including rapid multisectoral referral pathways, targeted training for referrers, standardised assessment procedures, multidisciplinary psychosocial care, cultural sensitivity, continuity of care, integration of clinical practice with research and teaching, collaborative treatment planning, and incorporation of experts by experience. These lessons emerged from the practical challenges involved in implementing a specialised CHR-P service within a decentralised public healthcare system with limited previous infrastructure. Conclusions The PREGAP experience suggests that implementing CHR-P services requires not only applying evidence-based recommendations, but also adapting them to the organisational and contextual realities of each healthcare system.