Health service barriers delay psychosis treatment
medwireNews: The nature of first contact with the mental health services impacts on how fast patients receive treatment for psychosis, say UK researchers.
They report that patients' duration of untreated psychosis (DUP) was significantly shorter if their first point of contact after referral was a specialist service, rather than a generic mental health service.
"What these data add is a considerable note of caution regarding initiatives to 'rebalance' services towards generic services, as this might risk disengagement and prolong DUP," say lead study author Max Birchwood (University of Birmingham, UK) and colleagues.
Their study involved 343 patients who were treated within a long-established early intervention service (EIS) in Birmingham, UK. The overall median DUP was 50 days, but the researchers indentified two subgroups: one that accessed the EIS within 6 months of symptom onset (median 19 days; n=228) and one that had a DUP of at least 6 months (median 518 days; n=115).
Patients in the longer DUP group were slow to seek help, taking a median of 66 days, but were rapidly referred to the mental health services, in a median of 4 days. However, they then faced a median delay of 141 days within the mental health services, before accessing the EIS.
A large part of the delay within the mental health services occurred when patients were referred to "generic" services - either adult or pediatric community mental health teams (CMHTs). This resulted in DUPs of over 300 days longer than if patients were referred to home treatment by a "crisis" team.
"Thus, the anticipated impact of EIS on reducing DUP appears to be failing in practice due to structural barriers in accessing this specialist service," write Birchwood et al in The British Journal of Psychiatry.
But they caution that "placing EIS in the frontline will not be a panacea for DUP reduction, since whatever service is placed there will have the difficult task of differentiating psychosis from the complexity of referrals mental health services routinely receive."
For those patients whose first referral was to a CMHT, the major cause of delay was early discharge, which occurred for about a third of patients and resulted in an average DUP of 631 days. This was mostly a result of patients not attending appointments, but was also because of failure to diagnosis psychosis, or referral to a different service, such as counseling.
"We should not be too surprised by these findings since historical and recent data suggest that young people with psychosis do not engage well with out-patient services such as CMHTs and are often discharged as a result," notes the team.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Eleanor McDermid, Senior medwireNews Reporter