title: Service users' views of moving on from early intervention services for psychosis: a longitudinal qualitative study in primary care.
abstract: BACKGROUND
  The 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.
  
  
  OBJECTIVE
  To explore service users' perspectives  of early intervention services and primary care, in-depth and over time.
  
  
  METHODS
  Longitudinal qualitative methodology in five geographically diverse sites across England.
  
  
  METHODS
  Semi-structured interviews with 21 young people with first-episode  psychosis at two time points.
  
  
  RESULTS
  Early 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.
  
  
  CONCLUSIONS
  Early 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.
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK. h.e.lester@bham.ac.uk
authors.forename: Helen
authors.initials: H
authors.lastname: Lester
authors.forename: Nagina
authors.initials: N
authors.lastname: Khan
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.forename: Max
authors.initials: M
authors.lastname: Marshall
authors.forename: David
authors.initials: D
authors.lastname: Fowler
authors.forename: Tim
authors.initials: T
authors.lastname: Amos
authors.forename: Max
authors.initials: M
authors.lastname: Birchwood
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D003266:Continuity of Patient Care / Q000592:standards; D061345:Early Medical Intervention / Q000592:standards*; D004739:England; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008605:Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000592:standards; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D055815:Young Adult