Reducing duration of untreated psychosis: a public health initiative in an urban setting

Background/Objectives: The first five years of psychosis are a critical period for effective treatment initiation with those experiencing first-episode psychoses. However, a long delay between onset of psychotic symptoms and access to appropriate care continues to be a feature of many care-pathways. Although many receive treatment within 6 months of symptom onset, others remain untreated in the community for 1–2 years. An in-depth evaluation of the care-pathways and help-seeking behaviour of clients with first-episode psychosis, therefore, has been conducted, with clients from Birmingham Early Intervention Service. This work will directly inform the development of a public health initiative to reduce duration of untreated psychosis (DUP).

Methods: Analysis of help-seeking behaviour through primary care, using both quantitative and qualitative analysis, in combination with qualitative interviews with community groups exploring attitudes and knowledge about mental health, to provide clear targets for the development and implementation of a public-health initiative in this large and diverse urban setting.

Results: 54 clients with DUP of >12months were found in a group of clients with first-episode psychosis. Initial analysis has shown them to have poor help-seeking behaviour, seeking help after onset of psychosis and to also experience delays within mental health services. Help-seeking contact via primary care was minimal, rarely presenting to their general practitioners (GPs) with any psychological symptoms prior to onset, with some help-seeking via religious/faith leaders.

Discussion/Conclusions: Our findings highlight the importance of focusing on both the personal and cultural identities of those who experience first-episode psychosis, in order to understand their help-seeking behaviour and to improve access to, and use of, appropriate mental health services. Our in-depth exploration of these care-pathways has been crucial to the development of our public-health initiative, providing clear targets for interventions with young people, their carers, religious/faith communities and GPs. Through these interventions we aim to reduce stigma and improve knowledge and attitudes about mental health and, thereby, reduce DUP.

Funding: National Institute for Health Research.

Keywords: Stigmatization, public health, psychosis.