Initiatives to shorten duration of untreated psychosis: systematic review

Lloyd‐Evans, Brynmor; Crosby, Michelle; Stockton, Sarah; Pilling, Stephen; Hobbs, Lorna; Hinton, Mark; Johnson, Sonia

doi:10.1192/bjp.bp.109.075622

Cited by 135 publications

(142 citation statements)

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“…Evidence for the effectiveness of such programmes in reducing DUP is patchy. 132 However, the ENRICH studies found that measurement of DUP alone does not capture the complexity of help-seeking in psychotic disorders and does not help elucidate critical BME differences in pathways to care. Rather than universal public education campaigns, researchers and practitioners need to develop public awareness programmes that are specifically focused on BME groups and test whether help-seeking pathways such as faith encounters can be targeted for reducing treatment delays and preventing adverse pathways.…”

Section: Do Black and Minority Ethnic Groups Mistrust Mental Health Smentioning

confidence: 99%

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

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BackgroundBlack and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.Aims and objectivesStudy 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.MethodsStudy 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’ResultsThere were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.ConclusionsStatutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Do Black and Minority Ethnic Groups Mistrust Mental Health Smentioning

confidence: 99%

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

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“…However, reducing DUP using community education and awareness campaigns has met with mixed results, 11 with evidence suggesting that neither general practitioner (GP) education 12 nor dedicated early intervention services (EIS) 13 by themselves reduce DUP or generate more treated cases. In exploring the reasons for these mixed findings, it has been argued that attention should be given to the component delays that contribute to DUP, such as individual help-seeking delays and delays within services, as well as its total duration.…”

mentioning

confidence: 99%

Reducing Duration of Untreated Psychosis: Care Pathways to Early Intervention in Psychosis Services

Birchwood¹,

Connor²,

Lester³

et al. 2014

Schizophrenia Research

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“…Drake et al 2000 ;Clarke et al 2006) and our findings regarding the relationship of DUP and DUI to longer-term outcomes are comparable with another study based on a nonspecialized program (Crumlish et al 2009). Furthermore, there is very limited evidence that the efforts of early intervention programs, including ours, to reduce treatment delay are effective in changing the distribution of DUP (Malla et al 2005 ;Lloyd-Evans et al 2011).…”

Section: Discussionmentioning

confidence: 98%

The role of treatment delay in predicting 5-year outcomes in an early intervention program

et al. 2011

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Initiatives to shorten duration of untreated psychosis: systematic review

Abstract: How early detection can be achieved is not clear. Evidence is most promising for intensive public awareness campaigns: these require organisation and resourcing at a regional or national level. More good-quality studies are needed to address gaps in knowledge.

Cited by 135 publications

References 46 publications

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Reducing Duration of Untreated Psychosis: Care Pathways to Early Intervention in Psychosis Services

The role of treatment delay in predicting 5-year outcomes in an early intervention program

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