title: Waiting time variation in Early Intervention Psychosis services: longitudinal evidence from the SEPEA naturalistic cohort study.
abstract: Early Intervention Psychosis [EIP] services have gained traction internationally, but are currently undergoing various forms of reconfiguration. In England, such services are now mandated to ensure 50% of accepted referrals commence care within 14 days, but no empirical evidence exists. We sought to estimate waiting times to EIP services in a large, representative epidemiological cohort in England, and investigate possible reasons for any variation.
  
  
  
  We estimated median waiting time from referral to acceptance by EIP services and investigated whether this varied by clinical, demographic or neighbourhood-level factors, amongst 798 participants, 16-35 years old, presenting to six EIP services over 3.5 years in a defined catchment area serving 2.5 million people. We used parametric survival analysis to inspect variation in waiting times (in days).
  
  
  
  Median waiting time was 15 days (interquartile range 7-30), although this varied across services (p < 0.01). Waiting times increased over the case ascertainment period by an average of 4.3 days (95% CI 1.3, 6.2; p < 0.01). Longer waiting times were associated with greater diagnostic uncertainty, indexed by an organic presentation (+ 9.1 days; 95% CI 1.9, 16.6; p < 0.01), polysubstance abuse (+ 2.6; 0.6, 3.9; p < 0.01), absence of psychotic disorder (+1.8; -0.1, 3.0; p = 0.05) and insidious onset (+1.8; -0.1, 3.0; p = 0.06). Waiting times did not vary by most demographic or neighbourhood-level characteristics.
  
  
  
  EIP services operate close to new waiting time standards in England, with little systematic variation by sociodemographic position. However, waiting times increased over the study period, coinciding with substantial service reorganisation. Longer waiting times associated with greater diagnostic uncertainty highlight opportunities to reduce delays in certain clinical groups at initial referral.
authors.affiliation: PsyLife Group, Division of Psychiatry, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK. j.kirkbride@ucl.ac.uk.|Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK. j.kirkbride@ucl.ac.uk.
authors.forename: James B
authors.identifier: 0000-0003-3401-0824
authors.initials: JB
authors.lastname: Kirkbride
authors.affiliation: Norfolk and Suffolk Foundation Trust, Norwich, Norfolk, NR6 5BE, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Hameed
authors.affiliation: Norfolk and Suffolk Foundation Trust, Norwich, Norfolk, NR6 5BE, UK.
authors.forename: L
authors.initials: L
authors.lastname: Wright
authors.affiliation: Norfolk and Suffolk Foundation Trust, Norwich, Norfolk, NR6 5BE, UK.
authors.forename: K
authors.initials: K
authors.lastname: Russell
authors.affiliation: Cambridgeshire and Peterborough Foundation Trust, NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, CB21 5EF, UK.
authors.forename: C
authors.initials: C
authors.lastname: Knight
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.|Cambridgeshire and Peterborough Foundation Trust, NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, CB21 5EF, UK.
authors.forename: J
authors.initials: J
authors.lastname: Perez
authors.affiliation: Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.|Cambridgeshire and Peterborough Foundation Trust, NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, CB21 5EF, UK.
authors.forename: P B
authors.initials: PB
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D061345:Early Medical Intervention / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011618:Psychotic Disorders / Q000628:therapy*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cohort studies; Early intervention (education); Health services research; Mental health services; Psychotic disorders