The Early Psychosis Intervention Programme in Singapore: A balanced scorecard approach to quality care

A/P Siow Ann Chong MBBS, MMed (Psychiatry), FAMSa*, Swapna Vermaa, S. Mythilya, Lye Yin Poona & Patrick D. McGorryba Institute of Mental Health and Woodbridge Hospital, Singaporeb ORYGEN Research Centre and ORYGEN Youth Health (formerly EPPIC and Youth Program, mhSKY)† Correspondence: A/PSiow Ann Chong, Senior Consultant Psychiatrist, Vice Chairman Medical Board (Research), Institute of Mental Health, 10, Buangkok View, Singapore, 539747, +65 6389 2000, +65 6315 0548 Siow_Ann_CHONG@imh.com.sgBackground: There is at present scant data published on actual early psychosis intervention programmes and their development. Most studies have focused on duration of untreated psychosis and outcomes.Aims: We present the development of a programme based on a business model which would provide a reference for other locations planning to set up similar services, especially in situations of limited resources.Method: This is a descriptive paper of a programme which operates on the “Balanced Scorecard” model. The various interventions, assessments and outcomes of the programme were compared with a historical group of the precursor service.Results: A total of 747 patients were accepted. The key outcomes included an increase in those diagnosed with and treated for psychosis, and a fall in the duration of untreated psychosis. There was a change in the referral pattern: a higher proportion sought help on their own and a fall in police referrals. Compared to the historical group, the rates of antipsychotic polypharmacy and benzodiazepines prescriptions were significantly lower, and the treatment default rate was significantly lower.Conclusions: A public mental health programme based on a business model could attain good clinical outcomes as well as facilitate better accountability to the various stakeholders.