I am grateful for Dr Agius' comments and entirely agree that a staging approach allows the development of a comprehensive care pathway for psychotic disorders. With such an approach, the most efficacious and potentially less harmful interventions can be appropriately targeted at an earlier clinical stage of an emerging illness. Such a staging model is widely used in medicine and has recently been described as a heuristic framework for intervening early in all youth mental health problems. ^{Reference McGorry, Purcell, Hickie, Young, Pantelis and Jackson1,Reference Francey, Nelson, Thompson, Parker, Kerr and Macneil2}

Half of all adult mental disorders begin in late adolescence, usually with an initial presentation of non-diagnostic symptoms. Mental health services, especially community mental health teams (CMHTs), offer interventions only when an illness is severe enough to reach a diagnostic threshold. This is partly due to the reactive nature of CMHT care and partly because of concerns about treating ‘false positives’, benign and transient states that will not make a transition into a major mental disorder. An unfortunate consequence of this well-meaning caution is that young people are denied earlier and safer interventions, which are not only clinically appropriate at an early stage, but have the potential for altering the prognosis and preventing the emergence of more serious illness.

A staging approach also offers exciting possibilities for developing specific clinical and biological markers of mental illnesses and understanding the relationship between clinical states and neuropathological and neurophysiological changes that accompany illness progression. ^{Reference Fusar-Poli, Howes, Allen, Broome, Valli and Asselin3}

I also share Dr Agius' concern about the short-term financial pressures that may encourage managers to amalgamate early intervention services into CMHTs. This will simply dilute the well-established effectiveness of early intervention services in caring for vulnerable young people, while offering no improvement in CMHT functioning.