title: Reducing duration of untreated psychosis: care pathways to early intervention in psychosis services.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. m.j.birchwood.20@bham.ac.uk
authors.forename: Max
authors.initials: M
authors.lastname: Birchwood
authors.forename: Charlotte
authors.initials: C
authors.lastname: Connor
authors.forename: Helen
authors.initials: H
authors.lastname: Lester
authors.forename: Paul
authors.initials: P
authors.lastname: Patterson
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
authors.forename: Max
authors.initials: M
authors.lastname: Marshall
authors.forename: David
authors.initials: D
authors.lastname: Fowler
authors.forename: Shôn
authors.initials: S
authors.lastname: Lewis
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.forename: Tim
authors.initials: T
authors.lastname: Amos
authors.forename: Linda
authors.initials: L
authors.lastname: Everard
authors.forename: Swaran P
authors.initials: SP
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services; D061345:Early Medical Intervention; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D011618:Psychotic Disorders / Q000628:therapy*; D012559:Schizophrenia / Q000628:therapy*; D013997:Time Factors