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It was pleasing to see this study by Strelchuk et al in the BJGP1 as more areas in the UK develop At Risk Mental State (ARMS) services as they aim to meet the requirements of the Long-Term Plan. GPs are crucial in the mental health pathway, but I worry that the burden of expectation is too high. Secondary care services are insufficiently aware of the concept of ARMS and the challenge in galvanising clinical and commissioning support is considerable. Traditionally, Early Intervention Services have embraced diagnostic uncertainty, but burgeoning caseloads would seem to have impacted on this in favour of self-preservation. Maybe the model for ARMS needs to be directed at community areas with a higher incidence of psychosis and to use support workers with lived experience who can follow the patient journey and advocate where necessary. This may be one of the ways of addressing the inequalities in treatment access and outcomes for Black, Asian, and minority ethnic communities where treatment is unfortunately more likely to be coercive.
- © British Journal of General Practice 2021
