Service users' views of moving on from early intervention services for psychosis: a longitudinal qualitative study in primary care

Abstract

BackgroundThe role of primary care for young people with psychosis, and transitions between specialist mental health services and primary care, are underexplored areas, both clinically and in research terms. AimTo explore service users' perspectives of early intervention services and primary care, in-depth and over time. Design and settingLongitudinal qualitative methodology in five geographically diverse sites across England. MethodSemi-structured interviews with 21 young people with first-episode psychosis at two time points. ResultsEarly intervention services are highly prized by service users; however, the 'gold standard' nature of the care is difficult to replicate in other services and may lead to unrealistic expectations. Flexibility in terms of the timing of discharge does appear to be happening in practice, but continuity is not always well established before discharge. Primary care seems to be under-utilised, both as a location of care during time with the early intervention service and as a skill set, particularly for physical health problems. Service users expected GPs to advocate for and navigate the health system, particularly at times of crisis or relapse. ConclusionEarly intervention services should focus on actively establishing relationships between service users and either the community mental health team or the GP in the months leading up to discharge, and ensuring that service users' expectations about access and availability of care are 'realistic'. Primary care could be better utilised, even when service users are actively engaged with early intervention services, to help ensure physical health needs are met from the start of treatment. Keywordscontinuity of care; health; primary care; psychoses; qualitative research.

General practitioner experience and perception of Child and Adolescent Mental Health Services (CAMHS) care pathways: a multimethod research study

“…Furthermore, service users may still be expecting primary care to provide more of the support required. For instance, a recent study on psychosis early intervention services for young people has shown that service users expect GPs to advocate for and navigate the health system 39. Indeed, one could argue for a more bottom-up framework for guiding, supporting and helping primary care workers to make clinical decisions and maintain a more active and open care pathway process.…”

Medication management following first-episode psychosis in young people: a developmental approach

“…Although some have argued against allocating resources to EIP teams, there is evidence to support their effectiveness, particularly during their engagement in an individual's treatment (Marshall 2011). Patient satisfaction with the EIP approach is also high (Lester 2011 More research is needed to determine the most effective ingredients of the EIP approach. It seems likely that one of the most important components is active engagement.…”

“…The emerging sense of an adult self and identity will be disrupted by the arrival of mental illness. This change in identity was explored in the study published by EDEN group mentioned earlier (Lester 2011). The young participants highlighted their experiences of a changed sense of self and of perceived stigma.…”

“…However, the art of engagement is subtle. The findings of the UK National Evaluation of the Development and Impact of Early Intervention Services (EDEN) group highlight how overzealous approaches by clinicians can be experienced as intrusive by young patients (Lester 2011).…”

Parity of esteem begins at home: translating empirical psychiatric research into effective public mental health

“…Also, there is evidence that every pound or dollar spent on EIS leads to exponential downstream cost savings; these are associated with fewer future inpatient admissions, lower future treatment costs for mental and physical health problems, and indirect savings associated with people remaining in or entering employment (Mihalopoulos et al 2009;McCrone et al 2011). Finally, EIS are seen as largely beneficial by the patients themselves and their carers (Lester et al 2011(Lester et al , 2012.…”