Early intervention in mental health has made great progress over the past 25 years through the prototype of early psychosis. Yet real world reform remains relatively piecemeal and comprehensive upscaling has not yet occurred to enable every person with psychotic illness to receive timely, personalised and sustained clinical care, in order to reach their full potential. Nevertheless, the beachhead and evidence base established by the EI paradigm in psychosis creates the conditions for this principle to be extended to the full diagnostic spectrum. EI has universal value in health care and the fluidity of our syndromal approach to diagnosis both cross-sectionally and longitudinally means that we cannot focus too narrowly. The clinical staging model may provide the framework for us to translate the principles of early intervention to a wide range of mental disorders.

New cultures of care appropriate to early intervention are needed and emerging. Through more refined prediction strategies and definition of underlying mechanisms we can also move towards the holy grail of a more personalised approach to treatment. Transdiagnostic research can be enabled if systems of care guarantee “soft entry” to new youth-oriented culture of care at the sub threshold stage, making stepwise expertise progressively available with functional recovery as the goal. We need to combine the power of the evidence-based paradigm with greater confidence, tenacity and much more intensive and professional advocacy in partnership with the general public.