Improving access to services for psychotic patients: does implementing a waiting time target make a difference

Abstract

Objective In April 2015, the English National Health Service started implementing the first waiting time targets in mental health care. This study aims to investigate the effect of the 14-day waiting time target for early intervention in psychosis (EIP) services after the first six months of its implementation. Study design We analyse a cohort of first-episode psychosis patients from the English administrative Mental Health and Learning Disabilities Dataset 2011 to 2015. We compare patients being treated by EIP services (treatment) with those receiving care from standard community mental health services (control). We combine non-parametric matching with a difference-indifference approach to account for observed and unobserved group differences. We analyse the probability of waiting below target and look at different percentiles of the waiting time distribution. Results EIP patients had an 11.6-18.4 percentage point higher chance of waiting below target post-policy compared to standard care patients. However, post-policy trends at different percentiles of the waiting time distribution were not different between groups. Conclusions Mental health providers seem to respond to waiting time targets in a similar way as physical health providers. The increased proportion waiting below target did not, however, result in an overall improvement across the waiting time distribution.

Early intervention in psychosis services: A systematic review and narrative synthesis of barriers and facilitators to seeking access

“…Mental health stigma is a key barrier and predicts DUP. Structural service barriers then further delay access to specialist services, despite the introduction of access and waiting times standards [48]. A synthesis of the qualitative studies generated three themes which both hinder and facilitate access to services: knowledge, stigma, and relationships , and an overarching analytic theme of intersectional knowledge and beliefs about self and others.…”

Sociodemographic and clinical predictors of delay to and length of stay with early intervention for psychosis service: findings from the CRIS-FEP study

“…Some studies show that patients aged 35 years and above present to EIS with a complex need [ 62 ], but there is limited evidence on which factors influence pathways to care for patients over 35 years old. A recent study investigated the effect of the 14-day waiting time target for EIS after the first 6 months of its implementation [ 63 ]. It showed promising signs that patients in EIS had a higher chance of being seen and assessed within the waiting time target.…”

Assessing implementation fidelity in the First Episode Rapid Early Intervention for Eating Disorders service model

“…The wait-time targets for the engagement call (<48 h), assessment (<2 weeks) and treatment (<4 weeks) are advisory and aspirational rather than obligatory. Although wait-time targets can reduce the wait for care, 17,18 they can have unintended consequences, such as tunnel vision (i.e. a focus on the target to such an extent that other important features of healthcare are neglected).…”