title: Don't turn your back on the symptoms of psychosis: a proof-of-principle, quasi-experimental public health trial to reduce the duration of untreated psychosis in Birmingham, UK.
abstract: BACKGROUND
  Reducing the duration of untreated psychosis (DUP) is an aspiration of international guidelines for first episode psychosis; however, public health initiatives have met with mixed results. Systematic reviews suggest that greater focus on the sources of delay within care pathways, (which will vary between healthcare settings) is needed to achieve sustainable reductions in DUP (BJP 198: 256-263; 2011).
  
  
  METHODS
  A quasi-experimental trial, comparing a targeted intervention area with a 'detection as usual' area in the same city. A proof-of-principle trial, no a priori assumptions are made regarding effect size; key outcome will be an estimate of the potential effect size for a definitive trial. DUP and number of new cases will be collected over an 18-month period in target and control areas and compared; historical data on DUP collected in both areas over the previous three years, will serve as a benchmark. The intervention will focus on reducing two significant DUP component delays within the overall care pathway: delays within the mental health service and help-seeking delay.
  
  
  CONCLUSIONS
  This pragmatic trial will be the first to target known delays within the care pathway for those with a first episode of psychosis. If successful, this will provide a generalizable methodology that can be implemented in a variety of healthcare contexts with differing sources of delay.
authors: CLAHRC, Birmingham & Solihull Mental Health Foundation Trust, 66-68 Hagley Road, B16 8PF, Birmingham, UK. c.s.connor@bham.ac.uk
authors: Charlotte
authors: C
authors: Connor
authors: Max
authors: M
authors: Birchwood
authors: Colin
authors: C
authors: Palmer
authors: Sunita
authors: S
authors: Channa
authors: Nick
authors: N
authors: Freemantle
authors: Helen
authors: H
authors: Lester
authors: Paul
authors: P
authors: Patterson
authors: Swaran
authors: S
authors: Singh
mesh_terms: D019985:Benchmarking; D019091:Critical Pathways; D057210:Delayed Diagnosis / Q000517:prevention & control*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration; D010342:Patient Acceptance of Health Care; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology; D006113:United Kingdom