Delays in mental health services and duration of untreated psychosis

Brunet, Kat; Birchwood, Max; Lester, Helen; Thornhill, Kate

doi:10.1192/pb.bp.106.013995

Cited by 45 publications

(58 citation statements)

References 13 publications

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“…It was also hypothesised that GPs in the intervention group would prospectively diagnose young people with first-episode psychosis at an earlier stage in the illness and, therefore, in the longer term decrease the duration of untreated psychosis. There was a possibility that, due to detection bias (that is, GPs in the intervention group identifying young people, some of whom had had the diagnosis for some time 15 ), cases in the control group might have a shorter duration of untreated psychosis during this trial. For these reasons, the number of people referred was chosen as a primary outcome, and the duration of untreated psychosis as one of the secondary outcomes.…”

Section: Introductionmentioning

confidence: 99%

REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis

Lester¹,

Birchwood²,

Freemantle³

et al. 2009

Br J Gen Pract

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Delays in accessing care for young people with a first episode of psychosis are significantly associated with poorer treatment response and higher relapse rates. AimTo assess the effect of an educational intervention for GPs on referral rates to early-intervention services and the duration of untreated psychosis for young people with first-episode psychosis. Design of studyStratified cluster randomised controlled trial, clustered at practice level. SettingBirmingham, England. MethodPractices with access to the three early-intervention services in three inner-city primary care trusts in Birmingham were eligible for inclusion. Intervention practices received an educational intervention addressing GP knowledge, skills, and attitudes about first-episode psychosis. The primary outcome was the difference in the number of referrals to earlyintervention services between practices. Secondary outcomes were duration of untreated psychosis, time to recovery, use of the Mental Health Act, and GP consultation rate during the developing illness. ResultsA total of 110 of 135 eligible practices (81%) were recruited; 179 young people were referred, 97 from intervention and 82 from control practices. The relative risk of referral was not significant: 1.20 (95% confidence interval [CI] = 0.74 to 1.95; P = 0.48). No effect was observed on secondary outcomes except for 'delay in reaching early-intervention services', which was statistically significantly shorter in patients registered in intervention practices (95% CI = 83.5 to 360.5; P = 0.002). ConclusionGP training on first-episode psychosis is insufficient to alter referral rates to early-intervention services or reduce the duration of untreated psychosis; however, there is a suggestion that training facilitates access to the new specialist teams for early psychosis. Keywordseducation; primary health care; psychosis. INTRODUCTIONDuring the last two decades, the importance of intervening as early as possible when a young person develops a first episode of psychosis has become accepted internationally. This has been underpinned by studies demonstrating that young people with first-episode psychosis experience lengthy delays between the onset of psychotic symptoms and receipt of treatment (duration of untreated psychosis) of up to 2 years, 1-3 and that delays in accessing care are significantly associated with poorer treatment response. 4 There is a limited evidence base in this area of primary care, but GPs may be key to the identification and management of first-episode psychosis, as they are usually the first point of patient contact, 5 their involvement in the management of psychosis is associated with a reduction of the use of the Mental Health Act, 6 and they are the most common final referral agent to early-intervention services.7 However, early detection presents challenges as psychosis can take several months to emerge, 8 and may be difficult to distinguish from normal adolescent behaviour and substance misuse.9,10 There can be changes in

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Section: Introductionmentioning

confidence: 99%

REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis

Lester¹,

Birchwood²,

Freemantle³

et al. 2009

Br J Gen Pract

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“…These findings point toward ethnic differences in the sub-phases of DUP, specifically, the help seeking delay from the time of symptom onset to first contact with health services, and the referral delay from first contact to entry into an appropriate treatment program. [39][40][41] Research from the United Kingdom found that contact with mental health services came later for Black-Caribbean patients, but, once contact was made, this group received psychiatric care sooner. Figure 1 The first contact on the pathway to care for people with first-episode psychosis from 3 ethnic groups in Ontario, n = 171…”

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confidence: 99%

Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario

et al. 2015

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Objective: To compare the pathways to care and duration of untreated psychosis (DUP) for people of Black-African, Black-Caribbean, or White-European origin with first-episode psychosis (FEP). Methods:We recruited a sample of 171 patients with FEP of Black-African, Black-Caribbean, and White-European origin from hospital-and community-based early intervention services (EIS) in the cities of Toronto and Hamilton. We compared the 3 groups on DUP and key indicators of the pathway to care. Results:We observed differences in pathways to care across the 3 groups. Black-Caribbean participants had an increased odds of referral from an inpatient unit to EIS (OR 3.33; 95% CI 1.46 to 7.60) and a decreased odds of general practitioner involvement on the pathway to care (OR 0.17; 95% CI 0.07 to 0.46), as well as fewer total contacts (exp[β] 0.77; 95% CI 0.60 to 0.99) when compared with White-European participants. Black-African participants had an increased odds of contact with the emergency department at first contact (OR 3.78; 95% CI 1.31 to 10.92). The differences in the DUP between groups were not statistically significant. Conclusions:Our findings suggest that there are significant differences in the pathways to EIS for psychosis for people of African and Caribbean origin in our Canadian context. It is essential to gain a comprehensive understanding of the pathways that different population groups take to mental health services, and the reasons behind observed differences, to inform the development of equitable services, targeting patients in the critical early stages of psychotic disorder.

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“…The standardised methodology (Brunet et al, 2007) produced results that are easily comparable with other international studies and different sociocultural contexts. Furthermore, the evaluation of pathways to care by means of several sources of information (patients, relatives, medical professionals) guaranteed the reliability of results.…”

Section: Discussionmentioning

confidence: 73%

“…This may be due to the difficulties of appropriately recognizing early psychotic symptoms, which are wrongly attributed to 'normal' adolescent behaviours (Brunet, Birchwood, Lester, & Thornhill, 2007), to the presence of physical illnesses or use of illicit drugs (Green, Young, & Kavanagh, 2005) or to temperamental characteristics . Moreover, these difficulties have been also attributed to a 'stigma' effect, with patients and relatives trying to avoid psychiatric consultations (Gerlinger, Hauser, & De Hert, 2013) or to organizational aspects of mental health services, such as being located in not easily accessible areas and not advertised (Anderson, Fuhrer, & Malla, 2010).…”

Section: Introductionmentioning

confidence: 99%

Pathways to care and duration of untreated psychosis in patients with a first episode of psychosis in Italy

Luciano

Sampogna

Vecchio

et al. 2016

International Journal of Culture and Mental Health

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This study aimed to examine the pathways to care and the duration of untreated psychosis (DUP) in first-episode psychosis patients in Italy. Sociodemographic and clinical characteristics of patients were collected using an ad-hoc schedule. Pathways to care of patients were evaluated by the Nottingham Onset Schedule, administered to patients, key-relatives and key-workers. Forty patients from the Department of Psychiatry of University of Naples were recruited. Mean duration of untreated illness (DUI) was 135.9±145.9 weeks, main DUP was 27.4±26.7 weeks. First helpseeking contact, often mediated by close relatives, took place after 21.6 ±43.8 weeks from symptoms onset and was with general practitioners, neurologists or psychologists. Only 25% immediately referred to psychiatrists. Patients had 1.8±0.8 contacts with non-psychiatric medical professionals before referring to the mental health service, and the mean time between first contact and adequate psychiatric treatments (referral delay) was 26.6±64.1 weeks. The DUI and DUP was longer in patients with less education (p < .05) and in those with an insidious onset of symptoms (p < .01). Targeted interventions and information campaigns on at-risk populations, such as young people and their relatives, could reduce the DUP, thus improving the long-term outcome of psychotic disorders. ARTICLE HISTORY

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Delays in mental health services and duration of untreated psychosis

Cited by 45 publications

References 13 publications

REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis

REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis

Pathways to First-Episode Care for Psychosis in African-, Caribbean-, and European-Origin Groups in Ontario

Pathways to care and duration of untreated psychosis in patients with a first episode of psychosis in Italy

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