Don't turn your back on the symptoms of psychosis: the results of a proof-of-principle, quasi-experimental intervention to reduce duration of untreated psychosis

Presentation First Author: 
Charlotte Connor

Introduction: The delay between the onset of a first episode of psychosis and receipt of treatment (DUP) has been consistently shown to predict poorer outcome for young people, however, no strategy to reduce DUP has been proven to be effective in the UK. This may be because DUP is an inherently complex construct with a variety of potential care pathway delays which may contribute to its duration. Our previous research identified that, in Birmingham, UK, long help-seeking delays and delays within mental health services were of prime concern in the care pathways of young people with long DUP. Objective: A proof-of-principle prospective study, targeting known sources of delay, to explore whether such initiatives can significantly reduce DUP in Birmingham, UK. Method: This was a quasi-experimental, proof-of-principle study, targeting mental health service delay and help-seeking delay through the introduction of a new youth access pathway for first-episode psychosis, alongside a psychosis awareness public heath campaign. Incident cases of first-episode psychosis from both areas were identified and their DUP and care pathways measured over the duration of the trial (July 2011 – Dec 2013). We also used extensive recent DUP data from the NIHR National EDEN study (Evaluating & Developing Early InterventioN Services) which was available to define the baseline. Results: The relative reduction in DUP in the intervention area, accounting for baseline period was 0.735 (95% CI 0.348 to 0.893; p=.0039) describing a clear relative reduction in DUP in the intervention area. Conclusion: Whilst our proof-of-principle trial did not include follow-up assessment of clinical symptoms or treatment outcome, issues which, given the evidence base, should be future priorities in future DUP research, the real world design of our proof-of-principle study was evidence based; targeting known sources of delay in our healthcare setting, firmly placed in the local context, with strong external validity, high quality collection of data from a baseline period and inclusion of a prospective control region, factors which will have served to increase the robustness of our evaluation. In light of these, we believe our findings to be promising and suggest that the methodology we have used may reduce the DUP of young people experiencing first-episode psychosis. Youth mental health is at the forefront of the UK political agenda and identification of an effective generalized methodology to reduce DUP, for use in a variety of healthcare contexts, sits well within this current political context.

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Date of Presentation: 
10th Oct 2015
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