title: Important first encounter: Service user experience of pathways to care and early detection in first-episode psychosis.
abstract: Long duration of untreated psychosis is associated with poor clinical and functional outcomes. However, few systematic attempts have been made to reduce this delay and little is known of service users' experience of early detection efforts.
  
  
  
  We explored service users' experience of an early detection service and transition to specialized treatment service, including pathway to care, understanding of illness and barriers to adequate assessment and treatment.
  
  
  
  In-depth interviews were conducted with 10 service users (median age 21, range 18-27, five males and five females) who were diagnosed with a first-episode non-affective psychosis and who were seen by an early detection team (TOP) and currently enrolled in a specialized early intervention service for this disorder (OPUS).
  
  
  
  Stigma and fear of the 'psychiatric system' were reported as significant barriers to help seeking, while family members were seen as a crucial support. Moreover, the impact of traumatic events on the experience and development of psychosis was highlighted. Finally, participants were relieved by the prospect of receiving help and the early detection team seemed to create a trusting relationship by offering a friendly, 'anti-stigmatized' space, where long-term symptomatology could be disclosed through accurate and validating questioning.
  
  
  
  Early detection services have two important functions. One is to make accurate assessments and referrals. The other is to instil hope and trust, and to facilitate further treatment by forming an early therapeutic alliance. The findings in this study provide important insights into the way in which early detection efforts and pathways to care are experienced by service users, with direct implications for improving psychiatric services.
authors.affiliation: Psychiatric Research Unit, Psychiatry Region Zealand, Copenhagen, Denmark.|Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Denmark.
authors.forename: Jens Einar
authors.initials: JE
authors.lastname: Jansen
authors.affiliation: Psychiatric Research Unit, Psychiatry Region Zealand, Copenhagen, Denmark.|Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Denmark.
authors.forename: Marlene Buch
authors.initials: MB
authors.lastname: Pedersen
authors.affiliation: Psychiatric Research Unit, Psychiatry Region Zealand, Copenhagen, Denmark.
authors.forename: Lene Halling
authors.initials: LH
authors.lastname: Hastrup
authors.affiliation: Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.|Early Psychosis Intervention Center, Psychiatry East, Region Zealand, Denmark.
authors.forename: Ulrik Helt
authors.initials: UH
authors.lastname: Haahr
authors.affiliation: Psychiatric Research Unit, Psychiatry Region Zealand, Copenhagen, Denmark.|Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Erik
authors.initials: E
authors.lastname: Simonsen
mesh_terms: D000293:Adolescent; D000328:Adult; D042241:Early Diagnosis; D018479:Early Intervention, Educational; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology; D055815:Young Adult
keywords: early intervention; first-episode psychosis; pathways to care; qualitative research; stigma