title: Prolonged duration of untreated psychosis: a problem that needs addressing.
abstract: The duration of untreated psychosis (DUP) refers to the period of time between the emergence of psychotic symptoms and the initiation of appropriate clinical treatment. Prolonged DUP is associated with a range of adverse consequences, including more severe illness course, cognitive deficits and poor functioning. Problems with recognition of illness and in seeking help contribute to DUP, but another major cause of prolonged DUP is delays within secondary mental health services. In an attempt to reduce these delays, National Health Service England and the Department of Health have set new targets to improve access to early intervention services which will come into effect in April 2016. Given this background, we aimed to examine the DUP and pathways to care of new patients entering an early intervention service. We also examined whether they were receiving National Institute for Health and Care Excellence (NICE) concordant treatment. This will enable us to establish a baseline so that the impact of the new targets can be determined and to assess the degree of change that will be required to implement these.
  
  
  
  De-identified electronic records of 165 patients accepted into the service over a 12-month period were analysed.
  
  
  
  Median DUP was 6 months. There was a median of 2 contacts prior to service entry. Community Mental Health Teams were the largest source of referrals.
  
  
  
  The majority of patients had a DUP exceeding the international target of 3 months. The findings appear to support previous evidence that this may be partially attributable to significant delays within the mental health care system.
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
authors.forename: Jack
authors.initials: J
authors.lastname: Cotter
authors.affiliation: Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Zabel
authors.affiliation: Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.|Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: French
authors.affiliation: Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.|Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.
authors.forename: Alison R
authors.initials: AR
authors.lastname: Yung
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008605:Mental Health Services; D011618:Psychotic Disorders / Q000628:therapy*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: duration of untreated psychosis; early intervention; pathways to care; psychosis