Evaluation of a community awareness programme to reduce delays in referrals to early intervention services and enhance early detection of psychosis.
BACKGROUND
Reducing treatment delay and coercive pathways to care are accepted aims for Early Intervention Services (EIS) for people experiencing first episode psychosis but how to achieve this is unclear. A one-year community awareness programme was implemented in a London EIS team, targeting staff in non-health service community organisations. The programme comprised psycho-educational workshops and EIS link workers, and offering direct referral routes to EIS. Its feasibility and its impact on duration of untreated psychosis and pathways to EIS were evaluated.


METHODS
Evaluation comprised: pre and post questionnaires with workshop participants assessing knowledge and attitudes to psychosis and mental health services; and a comparison of new service users' "service DUP"(time from first psychotic symptom to first contact with EIS) and pathways to care in the intervention year and preceding year. Focus groups sought stakeholders' views regarding the benefits and limitations of the programme and what else might promote help-seeking.


RESULTS
41 workshops at 36 community organisations were attended by 367 staff. 19 follow up workshops were conducted and 16 services were allocated an EIS link worker. Participants' knowledge and attitudes to psychosis and attitudes to mental health services improved significantly following workshops. In the year of the intervention, only 6 of 110 new service users reached EIS directly via community organisations. For all new referrals accepted by EIS, in the intervention year compared to the previous year, there was no difference in mean or median service DUP. A clear impact on pathways to care could not be discerned. Stakeholders suggested that barriers to referral remained. These included: uncertainty about the signs of early psychosis, disengagement by young people when becoming unwell, and worries about stigma or coercive treatment from mental health services. More general, youth focused, mental health services were proposed.


CONCLUSIONS
The community awareness programme did not reduce treatment delays for people experiencing first episode psychosis. Further research is needed regarding effective means to reduce duration of untreated psychosis. Although EIS services are guided to promote access through community engagement, this may not be an effective use of their limited resources.


BACKGROUND
Current Controlled Trial ISRCTN98260910 Registered 19th May 2010.
Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, W1W 7EJ, London, United Kingdom. b.lloyd-evans@ucl.ac.uk.
Brynmor
B
Lloyd-Evans
Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, W1W 7EJ, London, United Kingdom. asweeney@sgul.ac.uk.
Angela
A
Sweeney
Camden and Islington NHS Foundation Trust, Early Intervention Service, 4 Greenland Road, Camden, NW1, London, United Kingdom. markfhinton@hotmail.com.
Mark
M
Hinton
Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, W1W 7EJ, London, United Kingdom. nm432@cam.ac.uk.
Nicola
N
Morant
Department of Clinical, Education and Health Psychology, University College London, 1-19 Torrington Place, WC1E 7HB, London, United Kingdom. s.pilling@ucl.ac.uk.
Stephen
S
Pilling
Camden and Islington NHS Foundation Trust, Psychological Therapies Services, St Pancras Hospital, 4St Pancras Way, NW1 0PE, London, United Kingdom. Judy.Leibowitz@candi.nhs.uk.
Judy
J
Leibowitz
Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, W1W 7EJ, London, United Kingdom. h.killaspy@ucl.ac.uk.
Helen
H
Killaspy
Camden and Islington NHS Foundation Trust, Early Intervention Service, 4 Greenland Road, Camden, NW1, London, United Kingdom. sannatanskanen@hotmail.com.
Sanna
S
Tanskanen
Camden and Islington NHS Foundation Trust, Early Intervention Service, 4 Greenland Road, Camden, NW1, London, United Kingdom. j.totman@alumni.ucl.ac.uk.
Jonathan
J
Totman
Camden and Islington NHS Foundation Trust, Early Intervention Service, 4 Greenland Road, Camden, NW1, London, United Kingdom. jessica.armstrong@hotmail.co.uk.|Department of Psychology, University of Bath, BA2 7AY, 2SouthBath, United Kingdom. jessica.armstrong@hotmail.co.uk.
Jessica
J
Armstrong
Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, W1W 7EJ, London, United Kingdom. s.johnson@ucl.ac.uk.|Camden and Islington NHS Foundation Trust, Early Intervention Service, 4 Greenland Road, Camden, NW1, London, United Kingdom. s.johnson@ucl.ac.uk.
Sonia
S
Johnson
D000293:Adolescent; D000328:Adult; D042241:Early Diagnosis; D061345:Early Medical Intervention / Q000379:methods*; D004493:Education; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D015397:Program Evaluation; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D012017:Referral and Consultation; D055815:Young Adult