Given that most mental health disorders develop before the age of 25 (Solmi et al., 2022), providing support as soon as possible to young people showing early signs of possible mental illness is essential. Early intervention and preventative care have been shown to have a positive impact not only on mental health symptoms, but also physical health, employment, and other psychosocial outcomes (Clayborne et al., 2019; Shiers & Lester, 2014; Smith et al., 2021). In short: the earlier that young people get help, the less likely they are to develop mental health problems, and the more likely they are to stay well.
The efficacy of early interventions for emerging mental health problems in young people has been the focus of two recent reviews by a team at the NIHR Policy Research Unit in Mental Health at King’s College London and University College London.
- The first (Lee et al., 2026; henceforth referred to as ‘Umbrella Review’) was a review of systematic reviews of early interventions for those showing early signs of mental health problems, which identified substantial gaps in the availability of systematic reviews looking at symptoms of common mental disorders (CMD; e.g., anxiety, depression).
- Their second review (Appleton et al., 2025; henceforth referred to as ‘CMD Review’) filled this gap by looking at common mental disorders specifically.
Two reviews from the NIHR Policy Research Unit in the UK have examined early intervention approaches to improving care for people with initial signs of mental health difficulties.
Methods
Umbrella review
Systematic reviews of early interventions focused on alleviating symptoms of mental health disorders with a typical onset during youth (11-25 years-old) delivered to populations below age 65 were included. These were required to be complex interventions, i.e., interventions with more than one component, delivered by more than one person, and/or staged care models; delivered in community-based settings (or community teams that also work in acute settings). The outcomes of interest were: (i) the efficacy of early intervention programmes on mental health outcomes, (ii) implementation-related outcomes, and (iii) experiences related to these programmes.
CMD review
Studies were included if they investigated early interventions focused on alleviating symptoms of CMDs (anxiety disorders, depression, PTSD, psychological distress) delivered at first presentation to young people aged 11-25-years-old. These were also required to be complex interventions. The outcomes of interest were: (i) service outcomes such as wait times, referral acceptance, and service accessibility; (ii) mental health symptoms and psychosocial functioning; and (iii) other outcomes such as employment and housing.
Narrative synthesis was used to evaluate findings in both reviews. Reviews and studies of exclusively online interventions were excluded from both reviews.
Results
Umbrella review
Twenty-one systematic reviews were included. The majority (14/21) were of ‘moderate’ or ‘high’ quality (Shea et al., 2017), and were a mixture of systematic reviews, narrative reviews and syntheses, scoping reviews, meta-analyses and meta-syntheses, rapid reviews, and mixed-methods reviews. The age range of studies included in reviews was 10-60 years old, with sample sizes from five to 36,309.
Fifteen reviews focused on psychosis. Within this diagnosis, reviews fell into three primary themes:
- Early intervention for those at risk of developing psychosis: While some studies found significant effects, the most recent review did not find consistent evidence for a significant difference between early interventions and control conditions – many of which were active control groups (e.g., case management), meaning this may show promise for alleviating early difficulties.
- Reducing the duration of untreated psychosis: There was mixed evidence, although one review highlighted a small effect of early and detection intervention approaches even amongst studies without this as their primary target. Reviews of the implementation of these programmes revealed key implementation barriers, including stigma and service fragmentation, as well as facilitators, including the flexibility of services.
- Improving prognosis for people who have presented to services with a First Episode of Psychosis: Reviews indicated efficacy of these approaches on multiple outcomes, including remission and psychosocial functioning. Studies in these reviews comprised a broad range of treatment approaches, including psychological therapies and medications, with one review finding effects associated with the addition of case management to psychological interventions on negative symptoms and positive symptoms at 1-year followup.
Three reviews focused on eating disorders (EDs), with key targets of reducing the duration of untreated EDs and improving prognosis after service presentation. Review quality limited the clarity of the efficacy of these approaches on the outcomes of interest, but some high-quality studies indicated improvement in clinical outcomes such as weight and service outcomes such as waiting times.
Two reviews focused on transdiagnostic symptoms of CMDs, with a review on integrated community-based youth hubs finding some evidence for improvements across 11 eligible studies, but only one eligible study in a review of a variety of early intervention service models which saw improvement in some outcomes including psychosocial functioning.
One review focused on bipolar disorder. Only one study met the review’s inclusion criteria, which reported an improvement in outcomes.
There were no reviews for early intervention models for depression, anxiety, or ‘emerging personality disorders’; hence the need for the subsequent CMD review.
CMD review
Forty-three publications were included. These publications comprised a variety of study types, including six randomised controlled trials (RCTs) and one cluster RCT. The authors grouped studies into three primary themes, with intervention models designed to:
- Make care more comprehensive and integrated (15 studies): Studies targeted various aspects of service provision, including the connectedness of primary and secondary services, the flexibility of the referral process, and the individualisation of care.
- Increase the accessibility of, or reduce waiting times to being seen by services (13 studies): Studies addressed service accessibility and wait times through different measures, including offering brief support to those with less complex needs, and targeting specific underserved groups.
- Supporting young people with specific needs (10 studies), such as substance use and PTSD, and/or via housing and other social support.
On the specific outcomes:
- Waiting times (3 studies): All studies reporting this outcome were in theme (1) i.e., focused on making care more comprehensive and integrated. Multiple outcomes improved, including being seen more quickly by services and decreased emergency service usage.
- Accessibility (5 studies): These were split across themes (1) and (2). These studies also saw improvements; however, two studies reported an increase in service demand associated with the intervention, which in one study led to longer wait times.
- Mental health and wellbeing (11 studies): Split across all intervention designs, with the majority in theme (3). Some but not all interventions had a positive impact on mental health and wellbeing outcomes. Not all effects lasted, with two studies reporting significant differences compared to control at 6 months but not longer follow-ups (12-18 months), although two studies of substance abuse outcomes found effects at their longer (18-36 months), but not shorter follow-ups.
- Social functioning (4 studies): Some, but not all interventions focused on improving social outcomes (3), with improvements including beginning employment and reduced involvement in criminal justice.
- Cost-effectiveness (1 study): Only one study evaluated cost-effectiveness, with positive results.
- Acceptability (6 studies): Half of the studies that compared acceptability of the early intervention programme to a control group reported higher satisfaction with the early intervention. Acceptability was also positive in the studies with no control.
- Dropout (3 studies): There were mixed results in the three studies that reported this.
Studies identified multiple factors that were found to be associated with the outcomes, including age, ethnicity, first language, and case complexity.
There are a large variety of early intervention approaches for people showing signs of mental health problems, often designed to getting people to services as quickly as possible after symptoms begin, or improving outcomes once they have presented.
Conclusions
Across the two reviews, there was substantial variety in the types of early intervention employed, as well as outcomes measured. Broadly, many clinical approaches primarily addressed reducing the duration of time before a person experiencing a first episode of mental illness presents to services, and/or improving prognosis once they have presented to services. Other interventions targeted community-based and other types of service provision. The efficacy of early intervention approaches varied widely by diagnosis and intervention type, with some evidence for the efficacy of early intervention models on mental health and psychosocial outcomes, as well as some service-related outcomes.
Overall, there was more and stronger evidence for the efficacy of early intervention in psychosis compared to other diagnoses. However, both reviews indicated that effects of early intervention may not last, highlighting the fact that many young people will continue to need care even after early or preventative measures have been taken.
Early intervention approaches show promise for improving mental health outcomes, service accessibility, and more, but not all approaches are effective.
Strengths and limitations
Both reviews employed rigorous search strategies, with critical and systematic appraisal of study quality. Both reviews also included narrative commentaries from co-researchers with lived experience of mental health challenges, which strengthened and challenged the review findings. The use of narrative synthesis in the two reviews allowed for a broad variety of insights to be captured that have direct relevance to practitioners and commissioners considering early intervention approaches.
Due to the relatively low availability of literature, related to global inequities in research financing and publication, few studies from low- and middle-income countries (LMICs) were included in these two reviews. Future research should focus on the adaptation and validation of early intervention programming in LMIC settings in consultation with clinicians, researchers, and service users, as well as measuring their acceptability.
There were exclusion criteria that limited the inclusion of programme types that are commonly employed in early intervention. Specifically, digital interventions may offer special promise for early intervention and preventative programming due to their accessibility, cost-effectiveness, and appeal to younger audiences (e.g., Bergin et al. 2020). Hence, while there are substantive differences between exclusively digital programmes and those that involve at least some human contact, the exclusion of exclusively digital interventions in both reviews means that the full range of early intervention programming was not examined.
Likewise, in the CMD review, interventions based in educational settings were excluded. Educational settings may be another prime target for early intervention for youth mental health, particularly of symptoms of common mood disorders (Hoover & Bostic, 2020). Relatedly, the decision to focus on complex interventions generated a useful research question, but will have filtered out many programmes; simple interventions are often the first line of response, especially for CMDs. Indeed, in the umbrella review, 36 full-text publications were filtered out due to being ‘not early intervention/wrong setting’ and 23 were filtered out due to ‘no intervention complexity’. These results are not tabulated by diagnosis, but it seems possible that the exclusion of simple and digital interventions may have resulted in the low representation of eligible studies for early intervention in CMDs. These decisions allowed the reviews to address more specific research questions, but filtered out a number of relevant programme types.
While the umbrella review focused on symptoms of any mental health problem that typically begins before the age of 25, the age range of included studies was 10 to 60. While adults over the age of 25 are valid targets for early intervention, the timing, structure, and implementation of early intervention for young people (i.e., < 25 years old) and adults may differ significantly. The umbrella review focusing on young people would also have made its results more directly comparable with the CMD systematic review.
Finally, in the CMD review, the authors do not state how they derived their programme type groupings, or whether any other groupings were considered, which would have been informative to consider, given the diversity of implementation programme structures and outcomes examined.
The two reviews employed robust quality appraisal criteria to interesting research questions, but were the exclusion criteria too stringent?
Implications for practice
The reviews by Lee et al. (2026) and Appleton et al. (2025) have identified several critical areas for further research; in terms of diagnosis, there is an urgent need to conduct and evaluate more complex early intervention programmes in the contexts of emerging personality disorders and bipolar disorder, as well as disorders such as obsessive-compulsive disorder.
Findings on the acceptability of these interventions were promising and highlight how early intervention programmes may strengthen young people’s relationship with services at a critical time in their care. This is especially important considering a lifespan approach to mental illness, as some young people will continue to need mental health input at further points throughout their lives.
These reviews will serve as an excellent resource for commissioners and service leads to consult when considering, designing, and implementing early intervention models. They demonstrate that there is no dearth of early intervention models that have been evaluated in the evidence base. Researchers and service commissioners alike are under consistent pressure, often from funders, to innovate service delivery models. These reviews demonstrate the power, not solely of innovation, but of adaptation; there were rich and varied insights of programmes being implemented in specific service contexts or with specific populations, for example a review focusing on early intervention approaches for Indigenous youth in Australia (Jongen et al., 2023).
Finally, the lived experience accounts of these reviews offered fruitful insights for practitioners to consider, including the need to increase accessibility for marginalised and ‘hard to reach’ populations, the neglect of practitioner training and cultural competence in early intervention models, and the importance of needs-led (as opposed to diagnosis-led) interventions for emerging mental health symptoms. The lived experience narrative on the CMD review notes a critical systemic consequence of early intervention programmes, also recognised by the researchers: that due to their relative ease and speed of implementation, people with emerging mental health (and comorbid) issues of increased complexity are often not eligible for early intervention programmes. This means they sometimes actually end up waiting longer to be seen by services, increasing their complexity and paradoxically increasing costs for services. Intervention programmes, and the research studies that evaluate them, should consider lived experience co-production essential at every stage of implementation.
There are a variety of promising, validated early intervention programmes in the evidence base, which service commissioners can consider for implementation locally.
Statement of interests
Zoe Firth has no conflicts of interest to declare.
Edited by
Dr Nina Higson-Sweeney
Links
Primary papers
Rebecca Appleton, Phoebe Barnett, Connor Clarke, Jialin Yang, Sadiya Begum, Julian Edbrooke-Childs, … & Sonia Johnson (2025). Approaches to early intervention for common mental health problems in young people: a systematic review. BMC Medicine, 23(1), 651. https://doi.org/10.1186/s12916-025-04438-8
Jasmine Lee, Phoeve Barnett, Lucy P. Goldsmith, Jialin Yang, Rebecca Appleton, Brynmor Lloyd-Evans, … & Sonia Johnson (2026). Early interventions for first onset of symptoms of mental health conditions: an umbrella review of systematic reviews. BMC Medicine, 116. https://doi.org/10.1186/s12916-026-04617-1
Other references
Bergin, A. D., Vallejos, E. P., Davies, E. B., Daley, D., Ford, T., Harold, G., … & Hollis, C. (2020). Preventive digital mental health interventions for children and young people: a review of the design and reporting of research. NPJ Digital Medicine, 3(1), 133. https://doi.org/10.1038/s41746-020-00339-7
Clayborne, Z. M., Varin, M., & Colman, I. (2019). Systematic review and meta-analysis: adolescent depression and long-term psychosocial outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 58(1), 72-79. https://doi.org/10.1016/j.jaac.2018.07.896
Hoover, S., & Bostic, J. (2021). Schools as a vital component of the child and adolescent mental health system. Psychiatric Services, 72(1), 37-48. https://doi.org/10.1176/appi.ps.201900575
Jongen, C., Campbell, S., Saunders, V., Askew, D., Spurling, G., Gueorguiev, E., … & McCalman, J. (2023). Wellbeing and mental health interventions for Indigenous children and youth: A systematic scoping review. Children and Youth Services Review, 145, 106790. https://doi.org/10.1016/j.childyouth.2022.106790
Shea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Moran, J., … & Henry, D. A. (2017). AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 358. https://doi.org/10.1136/bmj.j4008
Shiers, D. & Lester, H. (2014). Why primary care matters for early intervention in psychiatry. In P. Byrne & A. Rosen (Eds.), Early Intervention in Psychiatry (pp. 147-159). John Wiley & Sons, Ltd.
Smith, N. R., Marshall, L., Albakri, M., Smuk, M., Hagell, A., & Stansfeld, S. (2021). Adolescent mental health difficulties and educational attainment: findings from the UK household longitudinal study. BMJ Open, 11(7), e046792. http://doi.org/10.5255/UKDA-SN-6614-13
Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., … & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281-295. https://doi.org/10.1038/s41380-021-01161-7
