BackgroundEthnic variations have previously been identified in the duration of untreated psychosis (DUP) and pathways into psychiatric services. These have not been examined in the context of early intervention services, which may alter these trajectories.AimsTo explore ethnic differences in the nature and duration of pathways into early intervention services.MethodIn a naturalistic cohort study, data were collected for 1024 individuals with psychotic disorders accepted for case management by eight London early intervention services.ResultsDuration of untreated psychosis was prolonged in the White British group compared with most other ethnic groups. White British individuals were more likely to make contact with their general practitioner and less likely to be seen within emergency medical services. All Black patient groups were more likely than their White British counterparts to experience involvement of criminal justice agencies.ConclusionsVariations continue to exist in how and when individuals from different ethnic groups access early intervention services. These may account for disparities in DUP.
MiData provides a clinician-friendly system of evaluating first-episode psychosis services but requires further refinement and dedicated resources to improve completion rates. This method of collecting routine data is of use to clinicians, managers, health service researchers and commissioners and potentially it may enable naturalistic comparisons between different models of care.
The study provides further evidence that negative reactions to psychotic episodes are relatively common. Clinicians may wish to assess for such symptoms. The study extended these findings by identifying a number of candidate psychological predictors of PTSD reactions such as perceptions of uncontrollability and absence of support. Prospective longitudinal studies are required to test the causal significance of these factors. More broadly, the findings indicate that traumatic stress in response to intra-psychic events such as delusions can be understood in similar ways to traumatic stress arising from physical traumas such as disasters.
Aims and MethodInformation concerning team staffing, keyworker case-loads, and keyworker diagnostic case-mix was collected from six community mental health teams caring for 1651 patients to establish the clinical burden across teams and professions.ResultsTeam case-loads varied from 427 to 121, an average of 275 patients. Over half the patients were female, and psychotic disorders constituted 44% of the sample. The most common diagnoses were schizophrenia (28.6%) and depression (23.6%). Keyworker case-loads varied across both teams and professions, averaging 30 patients per full-time equivalent. Psychiatrists' case-loads were the largest. Diagnostic case-mix varied with profession. Community psychiatric nurses had the largest proportion of patients with psychosis (73.8%).Clinical ImplicationsMulti-disciplinary community mental health teams have a shared view of appropriate work distribution. Consultant psychiatrists may underestimate the resources required by patients with non-psychotic disorders even in inner city areas.
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