Illustration symbolizing psychosis prevention with brain imagery and puzzle pieces

Is Early Intervention for Psychosis a Thing of the Past? Unpacking the Shifting Landscape of Mental Healthcare

Samir D’Costa in Health & Wellness December 2025 • 5 min read.

"From Promising Beginnings to Questionable Outcomes: A Critical Look at 'At Risk Mental State' Clinics and the Future of Psychosis Prevention"

The realm of mental healthcare is constantly evolving, with new approaches and strategies emerging to address the complex challenges of psychiatric disorders. One such approach, the concept of early intervention (EI) services, gained considerable traction with the aim of improving long-term outcomes for individuals experiencing their first episode of psychosis (FEP). These services, designed to identify and support individuals at the earliest stages of the illness, represented a significant shift towards proactive care.

Building on this early enthusiasm, a more targeted approach emerged with the creation of 'At Risk Mental State' (ARMS) clinics. These specialized services focused on identifying young people considered to be at ultra-high risk (UHR) of developing psychosis. The promise was clear: by intervening during this pre-psychotic phase, it might be possible to prevent or delay the onset of full-blown psychotic disorders. However, the landscape has become more complex, and the effectiveness of these clinics is now being critically re-evaluated.

This article will explore the trajectory of ARMS clinics, examining their initial promise and subsequent challenges. We will dissect the claims of success, the evidence of their impact, and the criticisms that have emerged. Ultimately, we will consider whether the future of psychosis prevention lies in a broader, public health approach that addresses the root causes of this devastating illness. It is crucial to understand the trajectory of these strategies to ensure effective and ethical mental healthcare delivery.

The Rise and Fall of ARMS Clinics: A Detailed Examination

Illustration symbolizing psychosis prevention with brain imagery and puzzle pieces

ARMS clinics, designed to be specialized mental health services, targeted young, help-seeking individuals believed to be at high risk of developing psychosis. The primary goal was to reduce the number of transitions from the 'At Risk Mental State' to a full-blown psychotic disorder. Early reports provided what seemed to be 'evidence-based recommendations' for treating these individuals, suggesting these clinics could prevent psychosis onset. However, the reality has proven to be more nuanced.

One of the primary challenges facing ARMS clinics is the difficulty in accurately identifying individuals truly at risk. The criteria for the 'At Risk Mental State' are complex, and can be difficult to apply consistently. This has led to a high rate of 'false positives' – individuals identified as being at risk who never develop psychosis. The very nature of the ARMS phase also complicates matters; the symptoms that define it can overlap with other mental health conditions like anxiety and depression, making accurate diagnosis even harder. This issue significantly impacts the effectiveness and reliability of the interventions provided.

Diagnostic Accuracy: The inherent challenges in defining and identifying the 'At Risk Mental State' lead to diagnostic uncertainty.
High False Positive Rates: A significant proportion of individuals identified as high-risk do not develop psychosis.
Symptom Overlap: Symptoms associated with ARMS often overlap with other mental disorders, making diagnosis more complicated.
Access to Care: The individuals seeking help may not always be representative of the broader population at risk.

Beyond the diagnostic challenges, the effectiveness of ARMS clinics in preventing the onset of psychosis is being questioned. While early studies reported promising results, more recent research indicates that transition rates from the ARMS phase to clinical psychosis may not be as high as previously suggested. There are also debates surrounding the ways the data is collected and analyzed, and whether the observed decrease in transition rates is due to successful intervention or a consequence of changes in patient samples or how the data is interpreted. These critical evaluations highlight the need for a more comprehensive and nuanced understanding of the role and impact of these clinics.

The Future of Psychosis Prevention: A Public Health Approach

The journey of psychosis prevention, particularly the role of ARMS clinics, presents a complex picture. While the concept of early intervention remains crucial, the current strategy’s limitations are clear. Perhaps the most promising way to improve outcomes involves focusing on public health approaches that target known risk factors. This involves educational campaigns, policy changes, and community-based programs. Prevention strategies must be multi-faceted. The future requires an integrated strategy: one that addresses the diagnostic challenges, considers the limitations of current interventions, and prioritizes public health strategies. This comprehensive approach provides a more effective and ethical approach to tackling this mental health crisis.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1017/s0033291718003859, Alternate LINK

Title: ‘At Risk Mental State’ Clinics For Psychosis – An Idea Whose Time Has Come – And Gone!

Subject: Psychiatry and Mental health

Journal: Psychological Medicine

Publisher: Cambridge University Press (CUP)

Authors: Olesya Ajnakina, Anthony S. David, Robin M. Murray

Published: 2018-12-26

Everything You Need To Know

What are 'At Risk Mental State' (ARMS) clinics, and what was their initial purpose?

'At Risk Mental State' (ARMS) clinics are specialized mental health services designed to identify and support young individuals considered at ultra-high risk (UHR) of developing psychosis. Their primary goal was to intervene during the pre-psychotic phase to potentially prevent or delay the onset of full-blown psychotic disorders. The initial promise was to reduce transitions from the 'At Risk Mental State' to psychosis using early interventions.

What are the main challenges associated with 'At Risk Mental State' (ARMS) clinics?

One major challenge is the difficulty in accurately identifying individuals truly at risk. The diagnostic criteria for the 'At Risk Mental State' are complex and can be difficult to apply consistently, leading to high 'false positive' rates. Moreover, symptoms associated with ARMS overlap with other mental health conditions like anxiety and depression, complicating accurate diagnosis. Additionally, questions have emerged on the data collection and analysis methods, calling into question whether decreased transition rates are due to successful intervention, or due to changes in patient samples or data interpretation.

How effective are 'At Risk Mental State' (ARMS) clinics in preventing psychosis, according to recent research?

While early studies on 'At Risk Mental State' (ARMS) clinics reported promising results, more recent research indicates that transition rates from the ARMS phase to clinical psychosis may not be as high as previously suggested. Critical evaluations have surfaced, questioning whether observed decreases in transition rates are indeed due to successful intervention or are influenced by changes in patient samples or how the data is interpreted. The effectiveness of ARMS clinics in preventing the onset of psychosis is actively being re-evaluated.

What is the alternative approach to psychosis prevention being considered, moving away from a focus on 'At Risk Mental State' (ARMS) clinics?

Given the limitations of 'At Risk Mental State' (ARMS) clinics, there's a potential shift towards a broader, public health approach. This involves targeting known risk factors for psychosis through educational campaigns, policy changes, and community-based programs. The aim is to implement multi-faceted prevention strategies that address the root causes of the illness and promote early intervention on a population-wide scale, which is intended to be a more ethical and effective approach to tackling this mental health challenge.

What does the future of psychosis prevention look like, considering the challenges and limitations of 'At Risk Mental State' (ARMS) clinics?

The future of psychosis prevention requires an integrated strategy. This strategy should address the diagnostic challenges of identifying the 'At Risk Mental State', consider the limitations of current interventions within 'At Risk Mental State' (ARMS) clinics, and prioritize public health strategies. A comprehensive approach provides a more effective and ethical way to tackle this mental health crisis, moving towards an emphasis on addressing the underlying causes of psychosis and promoting mental well-being across the entire population.