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Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services

  • Max Birchwood (a1), Charlotte Connor (a2), Helen Lester (a3), Paul Patterson (a4), Nick Freemantle (a5), Max Marshall (a6), David Fowler (a7), Shôn Lewis (a6), Peter Jones (a8), Tim Amos (a9), Linda Everard (a10) and Swaran P. Singh (a11)...
Abstract
Background

Interventions to reduce treatment delay in first-episode psychosis have met with mixed results. Systematic reviews highlight the need for greater understanding of delays within the care pathway if successful strategies are to be developed.

Aims

To document the care-pathway components of duration of untreated psychosis (DUP) and their link with delays in accessing specialised early intervention services (EIS). To model the likely impact on efforts to reduce DUP of targeted changes in the care pathway.

Method

Data for 343 individuals from the Birmingham, UK, lead site of the National EDEN cohort study were analysed.

Results

A third of the cohort had a DUP exceeding 6 months. The greatest contribution to DUP for the whole cohort came from delays within mental health services, followed by help-seeking delays. It was found that delay in reaching EIS was strongly correlated with longer DUP.

Conclusions

Community education and awareness campaigns to reduce DUP may be constrained by later delays within mental health services, especially access to EIS. Our methodology, based on analysis of care pathways, will have international application when devising strategies to reduce DUP.

Declarations of interest

None.

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Copyright
Corresponding author
Max Birchwood, PhD, DSc, CPsychol, FBPsS, School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Email: m.j.birchwood.20@bham.ac.uk
References
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Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services

  • Max Birchwood (a1), Charlotte Connor (a2), Helen Lester (a3), Paul Patterson (a4), Nick Freemantle (a5), Max Marshall (a6), David Fowler (a7), Shôn Lewis (a6), Peter Jones (a8), Tim Amos (a9), Linda Everard (a10) and Swaran P. Singh (a11)...
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eLetters

Reducing duration of untreated psychosis: Heterogeneity in challenges across the world

Sundar Gnanavel, Senior Resident, Department of Psychiatry
20 August 2013

Sir,

It is with great interest that I read the recent article titled "Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services".1 It deals with the all-important issue of evaluating if the current mental health care service models provide for early identification and efficient management of psychotic patients. The study provided interesting results including delay within mental health services as the prime culprit in the service pathway and theparadoxical observation that duration of untreated psychosis (DUP) was prolonged once individuals entered into mental health system.

I could not help comparing and visualising the study results if a similar study had been conducted in the setting of a developing country like India. The service model here is a far simpler bottom-up model where mental health services are integrated with primary health care services and district centres along with tertiary hospitals acting as final referral points for specialised services. There do not exist specialised services like community mental health care teams. I would anticipate delay in identification and referral to be the main culprits with little/no delay once an individual accesses mental health care services.

A previous study from India had evaluated the utility of a community based telephone help line in accessing mental health care services in first episode psychotic patients and found the same an useful supplementary strategy.2 This suggests innovative service delivery models can help in surmounting atleast some of the challenges faced even in a resource-scarce settings like in developing countries. It is the need of the day to replicate such studies in diverse settings across the globe to elucidate unique country-specific and culture-specific challenges in delivering mental health care services to psychotic patients in terms of both early identification and treatment. Constant efforts at optimisation of service delivery models will ensure "health for all" is not just an utopian slogan but a realistic target.

REFERENCES:

1. Birchwood M, Connor C, Lester H, Patterson P, Freemantle N, Marshall M et al. Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services. Br J Psychiatry 2013; 203:58-64.2. Shrivastava AK, Johnston ME, Stitt L, Thakar M, Sakel G, Iyer S et al. Reducing treatment delay for early intervention: evaluation of a communitybased crisis helpline. Ann Gen Psychiatry 2012; 11(1):20.

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Conflict of interest: None declared

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