The reality of at risk mental state services: a response to recent criticisms

Psychol Med. 2021 Jan;51(2):212-218. doi: 10.1017/S003329171900299X. Epub 2019 Oct 28.


Background: In the 1990s criteria were developed to detect individuals at high and imminent risk of developing a psychotic disorder. These are known as the at risk mental state, ultra high risk or clinical high risk criteria. Individuals meeting these criteria are symptomatic and help-seeking. Services for such individuals are now found worldwide. Recently Psychological Medicine published two articles that criticise these services and suggest that they should be dismantled or restructured. One paper also provides recommendations on how ARMS services should be operate.

Methods: In this paper we draw on the existing literature in the field and present the perspective of some ARMS clinicians and researchers.

Results: Many of the critics' arguments are refuted. Most of the recommendations included in the Moritz et al. paper are already occurring.

Conclusions: ARMS services provide management of current problems, treatment to reduce risk of onset of psychotic disorder and monitoring of mental state, including attenuated psychotic symptoms. These symptoms are associated with a range of poor outcomes. It is important to assess them and track their trajectory over time. A new approach to detection of ARMS individuals can be considered that harnesses broad youth mental health services, such as headspace in Australia, Jigsaw in Ireland and ACCESS Open Minds in Canada. Attention should also be paid to the physical health of ARMS individuals. Far from needing to be dismantled we feel that the ARMS approach has much to offer to improve the health of young people.

Keywords: At risk mental state; clinical high risk; prodromal; psychosis; schizophrenia; ultra high risk.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia
  • Canada
  • Humans
  • Ireland
  • Mental Health Services / standards*
  • Psychotic Disorders / therapy*
  • Risk Assessment
  • Surveys and Questionnaires