Are ethnic differences in pathways to care for psychosis in England reducing?

2019 ◽  
pp. 73-86
Author(s):  
Sherifat Oduola ◽  
Craig Morgan ◽  
Tom K.J. Craig
Keyword(s):  
Family Involvement ◽  
Ethnic Differences ◽  
Psychiatric Care ◽  
Population Based ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Black African ◽  
Minority Ethnic Groups ◽  
Episode Psychosis

Studies in the 1990s showed that, compared with the majority populations, people from minority ethnic groups in England were more likely to access psychiatric care via crisis routes. This chapter, and the studies it is based on, explore whether this adverse pattern continues. The authors analysed data from two population-based studies of first-episode psychosis (FEP) carried out 15 years apart. Participants for the studies were 193 FEP patients, aged 18–35 years, presenting to psychiatric care in South London between 1997 and 1999, and 265 FEP patients presenting in 2010–2012. The outcome measure was source of referral during first-episode psychosis. Results of the studies showed that, compared with 15 years ago, ethnic differences were not evident for police or GP involvement. However, ethnic minorities were more likely to access care via accident and emergency departments (Black Caribbean: adj. OR = 48.89; 95% CI = 3.49–684.71; Black African: adj. OR = 7.34; 95% CI = 1.15–46.74). It seems, from these results, that the disparities in pathways to care appear to be narrowing. This may be explained by changing socioeconomic factors and family involvement.

Improving outcomes: Factors influencing help-seeking behaviors in immigrants and ethnic minorities with first-episode psychosis

2016 ◽  
Vol 13 (03) ◽  
pp. 152-157
Author(s):  
A. O. Berg ◽  
K. Leopold ◽  
S. Zarafonitis-Müller ◽  
M. Nerhus ◽  
L. H. Stouten ◽  
...  
Keyword(s):  
Mental Health ◽  
Help Seeking ◽  
Service Use ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Factors Influencing ◽  
Increased Risk ◽  
Episode Psychosis ◽  
The Hague

Summary Background: Immigrants have increased risk of a poor recovery from first episode psychosis (FEP). Early treatment can improve prognosis, but having an immigrant background may influence pathways to care. Method: We present research of service use and factors influencing treatment outcome in immigrants with FEP. Service use was assessed in in-patients at an early intervention center in Berlin, Germany. Duration of untreated psychosis and beliefs about illness was assessed in a FEP study in Oslo, Norway and cognitive functioning in patients with FEP schizophrenia from the regular mental health services in The Hague, the Netherlands. The proportion of immigrants in Berlin and Oslo was at level with the local populations, while the proportion in The Hague appeared to be higher. Result: There were clear indications that mental health literacy, probably based in different cultural expectations, were lower in first generation immigrants (FGI). Findings regarding clinical insight were ambiguous. There were also indications that FGI had more cognitive problems, based in higher stress levels or in cognitive styles. Early psychosis services must take issues of immigration and ethnicity into consideration.

Estimating the incidence of first-episode psychosis using population-based health administrative data to inform early psychosis intervention services

2018 ◽  
Vol 49 (12) ◽  
pp. 2091-2099 ◽  
Author(s):  
Kelly K. Anderson ◽  
Ross Norman ◽  
Arlene G. MacDougall ◽  
Jordan Edwards ◽  
Lena Palaniyappan ◽  
...  
Keyword(s):  
Psychotic Disorder ◽  
Administrative Data ◽  
Catchment Area ◽  
Population Based ◽  
First Episode Psychosis ◽  
Case Definition ◽  
First Episode ◽  
Affective Psychosis ◽  
Health Administrative Data ◽  
Episode Psychosis

AbstractBackgroundDiscrepancies between population-based estimates of the incidence of psychotic disorder and the treated incidence reported by early psychosis intervention (EPI) programs suggest additional cases may be receiving services elsewhere in the health system. Our objective was to estimate the incidence of non-affective psychotic disorder in the catchment area of an EPI program, and compare this to EPI-treated incidence estimates.MethodsWe constructed a retrospective cohort (1997–2015) of incident cases of non-affective psychosis aged 16–50 years in an EPI program catchment using population-based linked health administrative data. Cases were identified by either one hospitalization or two outpatient physician billings within a 12-month period with a diagnosis of non-affective psychosis. We estimated the cumulative incidence and EPI-treated incidence of non-affective psychosis using denominator data from the census. We also estimated the incidence of first-episode psychosis (people who would meet the case definition for an EPI program) using a novel approach.ResultsOur case definition identified 3245 cases of incident non-affective psychosis over the 17-year period. We estimate that the incidence of first-episode non-affective psychosis in the program catchment area is 33.3 per 100 000 per year (95% CI 31.4–35.1), which is more than twice as high as the EPI-treated incidence of 18.8 per 100 000 per year (95% CI 17.4–20.3).ConclusionsCase ascertainment strategies limited to specialized psychiatric services may substantially underestimate the incidence of non-affective psychotic disorders, relative to population-based estimates. Accurate information on the epidemiology of first-episode psychosis will enable us to more effectively resource EPI services and evaluate their coverage.

scholarly journals Pathways to care for first-episode psychosis in an early detection healthcare sector

2005 ◽  
Vol 187 (S48) ◽  
pp. s24-s28 ◽  
Author(s):  
Jan Olav Johannessen ◽  
Tor K. Larsen ◽  
Inge Joa ◽  
Ingrid Melle ◽  
Svein Friis ◽  
...  
Keyword(s):  
Early Detection ◽  
First Episode Psychosis ◽  
Healthcare Sector ◽  
Service Development ◽  
Pathways To Care ◽  
First Episode ◽  
Access To Treatment ◽  
Episode Psychosis ◽  
Low Threshold

BackgroundEarly detection programmes aim to reduce the duration of untreated psychosis (DUP) by public education and by prompt access to treatment via active outreach detection teams.AimsTo determine whether those with first-episode psychosis in an early detection healthcare area with existing referral channels differ from those who access care via detection teams.MethodThose with first-episode psychosis recruited via detection teams were compared with those accessing treatment via conventional channels, at baseline and after 3 months of acute treatment.ResultsPatients recruited via detection teams are younger males with a longer DUP a less dramatic symptom picture and better functioning; however they recover more slowly, and have more symptoms at 3-month follow-up.ConclusionsAfter establishing low threshold active case-seeking detection teams, we found clear differences between those patients entering treatment via detection teams v. those obtaining treatment via the usual channels. Such profiling may be informative for early detection service development.

Family involvement in first-episode psychosis

2019 ◽  
pp. 117-130
Author(s):  
Greeshma Mohan ◽  
R. Padmavati ◽  
R. Thara
Keyword(s):  
Treatment Adherence ◽  
Family Involvement ◽  
First Episode Psychosis ◽  
First Episode ◽  
Rapid Urbanization ◽  
Episode Psychosis ◽  
The Family ◽  
Expanding Population

In the Indian secular, pluralistic, and collectivist society, the family is the oldest and the most important institution that has survived through the ages. With rapid urbanization and an ever-expanding population, there is a scarcity of financial and human resources in the area of mental health. Though progressively decreasing in size, families continue to provide a valuable support system, which can be helpful in the management of various stressful situations. Yet, very often this resource is not adequately and appropriately utilized. This chapter describes the role of family involvement in first-episode psychosis, drawing from various research projects carried out by the Schizophrenia Research Foundation (SCARF) and from other Indian centres. It deals with the identification of prodromes, access to care, treatment adherence and follow-up, and stigma.

Pathways to Care, Duration of Untreated Psychosis and Treatments Received by Patients with First-Episode Psychosis

2011 ◽  
Vol 26 (S2) ◽  
pp. 1394-1394
Author(s):  
D. Giacco ◽  
A. Fiorillo ◽  
V. Del Vecchio ◽  
M. Luciano ◽  
G. Sampogna ◽  
...  
Keyword(s):  
Health Professionals ◽  
Suicide Attempts ◽  
Hospital Admissions ◽  
Psychiatric Treatment ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Duration Of Untreated Psychosis ◽  
Long Term Outcome ◽  
Episode Psychosis

IntroductionPathways to care and duration of untreated psychosis (DUP) strongly influence the long-term outcome of schizophrenia.AimsTo investigate pathways to care, duration of untreated psychosis (DUP) and treatments received by a sample of individuals aged between 18 and 35 years meeting diagnostic criteria for psychosis.MethodsPathways to care and DUP were explored by an “ad-hoc” schedule administered to patients and caregivers.ResultsThe sample consists of 30 patients. The first episode of psychosis, which occurred at 19.7 (± 4.7) years, was characterized by negative symptoms and disorganized behaviours in more than half of the sample, suicide attempts (28%) and hospital admissions (26%). DUP was 41.6 ± 60.4 weeks, being longer than that reported in international literature. In 76% of cases patients’ relatives asked for a first contact with health professionals, referring the patients to psychiatrists (34% of cases), general practitioners (31%), neurologists (21%) or psychologists (13%). When professionals other than psychiatrists were contacted, the interval between the contact and receipt of appropriate psychiatric treatment (according to the current guidelines) was particularly long (15.2 ± 32.1 weeks). 34% of patients were treated with a monotherapy of psychotropic drugs: 24% with antipsychotics, 7% with anxiolytics and 3% with antidepressants; 48% received a poly-pharmacotherapy. 35% were treated with psychotherapy (in most of the cases cognitive-behavioural therapy), which was the only treatment for 18% of patients.ConclusionsThese results emphasize the need to train health professionals on diagnosis and treatment of first episode psychosis. DUP may be reduced by anti-stigma campaigns among general population.

scholarly journals Criminal justice pathways to psychiatric care for psychosis

2015 ◽  
Vol 207 (6) ◽  
pp. 523-529 ◽  
Author(s):  
Kamaldeep Bhui ◽  
Simone Ullrich ◽  
Constantinos Kallis ◽  
Jeremy W. Coid
Keyword(s):  
Criminal Justice ◽  
Drug Use ◽  
Psychiatric Care ◽  
Care Pathway ◽  
Population Based ◽  
First Episode ◽  
Black African ◽  
Black Caribbean ◽  
African Patients ◽  
First Contact

BackgroundSome patients are at higher risk of contact with criminal justice agencies when experiencing a first episode of psychosis.AimsTo investigate whether violence explains criminal justice pathways (CJPs) for psychosis in general, and ethnic vulnerability to CJPs.MethodTwo-year population-based survey of people presenting with a first-episode of psychosis. A total of 481 patients provided information on pathways to psychiatric care. The main outcome was a CJP at first contact compared with other services on the care pathway.ResultsCJPs were more common if there was violence at first presentation (odds ratio (OR) = 4.23, 95% CI 2.74–6.54, P<0.001), drug use in the previous year (OR = 2.28, 95% CI 1.50–3.48, P<0.001) and for high psychopathy scores (OR = 2.54, 95% CI 1.43–4.53, P = 0.002). Compared with White British, CJPs were more common among Black Caribbean (OR = 2.97, 95% CI 1.54–5.72, P<0.001) and Black African patients (OR = 1.95, 95% CI 1.02–3.72, P = 0.01). Violence mediated 30.2% of the association for Black Caribbeans, but was not a mediator for Black African patients. These findings were sustained after adjustment for age, marital status, gender and employment.ConclusionsCJPs were more common in violent presentations, for greater psychopathy levels and drug use. Violence presentations did not fully explain ethnic vulnerability to CJPs.

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