Early Intervention in the Real World From research to practice: how OPUS treatment was accepted and implemented throughout Denmark Merete Nordentoft, 1,2 Marianne Melau, 1 Tina Iversen, 1 Lone Petersen, 1 Pia Jeppesen, 1 Anne Thorup, 1,2 Mette Bertelsen, 1 Carsten Rygaard Hjorthøj, 1,2 Lene Halling Hastrup 4 and Per Jørgensen 3 1 Mental Health Centre Copenhagen, Mental health Services Capital Region of Denmark, 2 The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, 3 Center for Psychiatric Research, University of Aarhus, Risskov, and 4 Psychiatric Research Unit, Region Zealand and The Development Unit SPIR, Copenhagen, Denmark Corresponding author: Professor Merete Nordentoft, Psychiatric Centre Copenhagen, Mental Health Services Capital Region of Denmark, Copenhagen University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark. E-mail: mn@dadlnet.dk Received 19 March 2013; accepted 10 October 2013 Abstract Background: The early phases of psychosis have been hypothesized to constitute a critical period, a window of opportunity. At the same time, the early phases of psychosis are associ- ated with increased risk of unwanted outcome, such as suicidal behaviour and social isolation. This was the background for the emergence of early intervention services, and in Denmark, the OPUS trial was initiated as part of that process. Methods: Modified assertive commu- nity treatment, together with family involvement and social skills training, constituted the core elements in the original programme. A total of 547 patients with first-episode psychosis were included in the trial. Results: To summarize briefly the results of the OPUS trial: the OPUS treatment was superior to standard treatment in reducing psychotic and negative symptoms and substance abuse, in increasing user satisfaction and adherence to treatment, and in reducing use of bed days and days in supported housing. Moreover, rela- tives included in the OPUS treatment were less strained and had a higher level of knowledge about schizophre- nia and higher user satisfaction. Discussion: The OPUS treatment was implemented throughout Denmark. Training courses were developed and manuals and books were published. Regional health authorities had access to national grants for imple- menting early intervention services; as a result, OPUS teams were dissemi- nated throughout the country. The content of the treatment is now further developed, and new elements are being tried out – such as individ- ual placement and support, lifestyle changes, cognitive remediation, spe- cialized treatment for substance abuse and different kinds of user involvement. Key words: early intervention services, implementation, longitudinal, psychosis, rct BACKGROUND Early intervention services have been under devel- opment for almost 20 years, and then disseminated throughout Denmark. The background for the OPUS trial was the awareness of the huge difficulties associated with the early phases of psychosis. When a young person suffers a psychotic illness, it has severe consequences for both the individual and his or her relatives. In some cases, the symptoms have been present for some time, and social conse- quences may already be present – for instance, loss of job or school affiliation, social isolation, changed interests and habits, and diurnal rhythm. In most cases, both the young person and the family have no comprehension of the impact and consequences of the illness, and are not informed about helpful and necessary precautions. The early phases of psy- chosis are associated with the highest risk of such complications as suicidal acts, 1 development of co-morbid substance use and criminality. 2 It has been hypothesized that the first 5 years of treatment are a critical period that can be a window of oppor- tunity. During this time, the possibilities to change Early Intervention in Psychiatry 2013; ••: ••–•• doi:10.1111/eip.12108 First Impact Factor released in June 2010 and now listed in MEDLINE! © 2013 Wiley Publishing Asia Pty Ltd 1