scholarly journals Où en sommes-nous? An Overview of Successes and Challenges after 30 Years of Early Intervention Services for Psychosis in Quebec: Où en sommes-nous? Un aperçu des réussites et des problèmes après 30 ans de services d’intervention précoce pour la psychose au Québec

2020 ◽  
Vol 65 (8) ◽  
pp. 536-547
Author(s):  
Bastian Bertulies-Esposito ◽  
Marie Nolin ◽  
Srividya N. Iyer ◽  
Ashok Malla ◽  
Phil Tibbo ◽  
...  
Keyword(s):  
Early Intervention ◽  
Organizational Support ◽  
Online Survey ◽  
Essential Elements ◽  
Provincial Government ◽  
First Episode ◽  
Cross Sectional ◽  
Early Intervention Services ◽  
Essential Components ◽  
Intervention Services

Introduction: Over the last 30 years, early intervention services (EIS) for first-episode psychosis (FEP) were gradually implemented in the province of Quebec. Such implementation occurred without provincial standards/guidelines and policy commitment to EIS until 2017. Although the literature highlights essential elements for EIS, studies conducted elsewhere reveal that important EIS components are often missing. No thorough review of Quebec EIS practices has ever been conducted, a gap we sought to address. Methods: Adopting a cross-sectional descriptive study design, an online survey was distributed to 18 EIS that existed in Quebec in 2016 to collect data on clinical, administrative, training, and research variables. Survey responses were compared with existing EIS service delivery recommendations. Results: Half of Quebec’s population had access to EIS, with some regions having no programs. Most programs adhered to essential components of EIS. However, divergence from expert recommendations occurred with respect to variables such as open referral processes and patient–clinician ratio. Nonurban EIS encountered additional challenges related to their geography and lower population densities, which impacted their team size/composition and intensity of follow-up. Conclusions: Most Quebec EIS offer adequate services but lack resources and organizational support to adhere to some core components. Recently, the provincial government has created EIS guidelines, invested in the development of new programs and offered implementation support from the National Centre of Excellence in Mental Health. These changes, along with continued mentoring and networking of clinicians and researchers, can help all Quebec EIS to attain and maintain recommended quality standards.

Views of Young People in Early Intervention Services for First-Episode Psychosis in England

2011 ◽  
Vol 62 (8) ◽  
pp. 882-887 ◽  
Author(s):  
Helen Lester ◽  
Max Marshall ◽  
Peter Jones ◽  
David Fowler ◽  
Tim Amos ◽  
...  
Keyword(s):  
Early Intervention ◽  
Young People ◽  
First Episode Psychosis ◽  
First Episode ◽  
Early Intervention Services ◽  
Episode Psychosis ◽  
Intervention Services

scholarly journals Context and contact: a comparison of patient and family engagement with early intervention services for psychosis in India and Canada

2020 ◽  
pp. 1-10
Author(s):  
Srividya N. Iyer ◽  
Ashok Malla ◽  
Aarati Taksal ◽  
Anika Maraj ◽  
Greeshma Mohan ◽  
...  
Keyword(s):  
Early Intervention ◽  
Family Involvement ◽  
Proportional Hazards ◽  
Family Engagement ◽  
Cox Proportional Hazards ◽  
First Episode ◽  
Early Intervention Services ◽  
Service Engagement ◽  
Intervention Services ◽  
Family Contact

Abstract Background It is unknown whether patient disengagement from early intervention services for psychosis is as prevalent in low- and middle-income countries (LMICs) like India, as it is in high-income countries (HICs). Addressing this gap, we studied two first-episode psychosis programs in Montreal, Canada and Chennai, India. We hypothesized lower service disengagement among patients and higher engagement among families in Chennai, and that family engagement would mediate cross-site differences in patient disengagement. Methods Sites were compared on their 2-year patient disengagement and family engagement rates conducting time-to-event analyses and independent samples t tests on monthly contact data. Along with site and family involvement, Cox proportional hazards regression included known predictors of patient disengagement (e.g. gender). Results The study included data about 333 patients (165 in Montreal, 168 in Chennai) and their family members (156 in Montreal, 168 in Chennai). More Montreal patients (19%) disengaged before 24 months than Chennai patients (1%), χ2(1, N = 333) = 28.87, p < 0.001. Chennai families had more contact with clinicians throughout treatment (Cohen's d = −1.28). Family contact significantly predicted patient disengagement in Montreal (HR = 0.87, 95% CI 0.81–0.93). Unlike in Chennai, family contact declined over time in Montreal, with clinicians perceiving such contact as not necessary (Cohen's d = 1.73). Conclusions This is the first investigation of early psychosis service engagement across a HIC and an LMIC. Patient and family engagement was strikingly higher in Chennai. Maintaining family contact may benefit patient engagement, irrespective of context. Findings also suggest that differential service utilization may underpin cross-cultural variations in psychosis outcomes.

scholarly journals Loneliness in early psychosis: A qualitative study exploring the views of mental health practitioners in early intervention services

2020 ◽  
Author(s):  
Theodora Stefanidou ◽  
Jingyi Wang ◽  
Nicola Morant ◽  
Brynmor Lloyd-Evans ◽  
Sonia Johnson
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Public Health Problem ◽  
Early Psychosis ◽  
Mental Health Practitioners ◽  
First Episode ◽  
Physical And Mental Health ◽  
Early Intervention Services ◽  
Health Practitioners ◽  
Intervention Services

Abstract Background: Loneliness is an important public health problem with established adverse effects on physical and mental health. Although, people with psychosis often experience high levels of loneliness, relatively little is known about the relationship between loneliness and early psychosis. Potential interventions to address loneliness might be easier to implement early in the illness when social networks and social skills may be more intact than at a later stage. We investigated the views of mental health practitioners about the context and causes of loneliness in people with early psychosis, and about potential interventions.Methods: Semi-structured face-to-face interviews were conducted with mental health practitioners (n=20). Participants were purposively recruited from four early intervention services for first-episode psychosis in the UK. Interviews were transcribed verbatim and thematic analysis was conducted.Results: Participants believed that the majority of service users with early psychosis experience feelings of loneliness. They often saw socially isolated and disconnected clients and believed them to be lonely, but rarely discussed loneliness explicitly in clinical interactions. A combination of symptoms, stigma and negative sense of self were believed to underpin loneliness. Participants could not identify any specific current interventions delivered by their services for tackling loneliness, but thought some routinely provided interventions, including social groups and psychological treatments, could be helpful. They favoured making a wider range of loneliness interventions available and believed that community agencies beyond mental health services should be involved to make these effective and feasible to deliver. They suggested social participation interventions without an explicit mental health focus as potentially promising and valued a co-produced approach to intervention development. Conclusions: This study suggests that loneliness is not routinely discussed in early intervention services, and a targeted strategy for tackling it is lacking. Co-produced, individualised community approaches, and interventions that target symptoms, stigma and negative self-schemas might be beneficial in alleviating loneliness for people with early psychosis. Empirical research is needed to develop and test such interventions.

scholarly journals Layers of listening: Qualitative analysis of the impact of early intervention services for first-episode psychosis on carers' experiences

2015 ◽  
Vol 207 (2) ◽  
pp. 135-142 ◽  
Author(s):  
Anna Lavis ◽  
Helen Lester ◽  
Linda Everard ◽  
Nicholas Freemantle ◽  
Tim Amos ◽  
...  
Keyword(s):  
Early Intervention ◽  
Young People ◽  
Help Seeking ◽  
Young Person ◽  
First Episode Psychosis ◽  
First Episode ◽  
Early Intervention Services ◽  
Episode Psychosis ◽  
Intervention Services ◽  
The Impact

BackgroundEarly intervention services (EIS) comprise low-stigma, youth-friendly mental health teams for young people undergoing first-episode psychosis (FEP). Engaging with the family of the young person is central to EIS policy and practice.AimsBy analysing carers' accounts of their daily lives and affective challenges during a relative's FEP against the background of wider research into EIS, this paper explores relationships between carers' experiences and EIS.MethodSemi-structured longitudinal interviews with 80 carers of young people with FEP treated through English EIS.ResultsOur data suggest that EIS successfully aid carers to support their relatives, particularly through the provision of knowledge about psychosis and medications. However, paradoxical ramifications of these user-focused engagements also emerge; they risk leaving carers' emotions unacknowledged and compounding an existing lack of help-seeking.ConclusionsBy focusing on EIS's engagements with carers, this paper draws attention to an urgent broader question: as a continuing emphasis on care outside the clinic space places family members at the heart of the care of those with severe mental illness, we ask: who can, and should, support carers, and in what ways?

scholarly journals A Rapid Learning Health System to Support Implementation of Early Intervention Services for Psychosis in Quebec, Canada: Study Protocol

2021 ◽  
Author(s):  
Manuela Ferrari ◽  
Srividya Iyer ◽  
Annie Leblanc ◽  
Marc-André Roy ◽  
Amal Abdel-Baki
Keyword(s):  
Early Intervention ◽  
Real Time ◽  
Preliminary Evidence ◽  
Mobile App ◽  
Service Users ◽  
Scan Design ◽  
Rapid Learning ◽  
Early Intervention Services ◽  
Essential Components ◽  
Intervention Services

Abstract Background: Given the strong evidence for their effectiveness, early intervention services for psychosis (EIS) are being widely implemented. However, heterogeneity in the implementation of essential components, remains an ongoing challenge. Rapid learning health systems (RLHS), that embed data collection in clinical settings for real-time learning and continual quality improvement, can address this challenge. We therefore implemented a RLHS in 11 EIS in Quebec, Canada. This project aims to determine the feasibility and acceptability of implementing a RLHS in EIS, and to assess its impact on compliance with standards for essential EIS components. Methods: Following literature recommendations, the implementation of this RLHS involves six iterative phases: external and internal scan, design, implementation, evaluation, adjustment, and dissemination. Multiple stakeholder groups (service users, families, clinicians, researchers, decision makers, provincial EIS association) are involved in all phases. Meaningful indicators of EIS quality (e.g., satisfaction, timeliness of response to referrals) were selected based on literature review, provincial guidelines, and stakeholder consensus on indicators prioritisation. A digital infrastructure was designed and deployed that comprises (a) a user-friendly interface for routinely collecting data from programs (b) a digital terminal and mobile app to collect feedback from service users and families regarding care received, health, and quality of life (c) data analytic, visualization and reporting functionalities to provide participating programs with real-time feedback on their performance over time, and in relation to standards and to other programs, along with tailored recommendations. Community of practice activities are being conducted that leverage insights from data to build capacity among programs to continually progress towards aligning their practice with standards/best practices. Guided by the RE-AIM framework, we are collecting quantitative and qualitative data on the Reach, Effectiveness Adoption, Implementation and Maintenance of our RLHS. These RE-AIM data will be analyzed to evaluate our RLHS’s impacts. Discussion: This project will yield valuable insights about how a RLHS can be implemented by EIS, along with preliminary evidence for its acceptability, feasibility and impacts on program-level outcomes. Its findings will refine our RLHS further and advance approaches that bring data, stakeholder voices and collaborative learning to improve outcomes and service quality in psychosis. Trial registration: NA

scholarly journals Loneliness in early psychosis: a qualitative study exploring the views of mental health practitioners in early intervention services

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Theodora Stefanidou ◽  
Jingyi Wang ◽  
Nicola Morant ◽  
Brynmor Lloyd-Evans ◽  
Sonia Johnson
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Public Health Problem ◽  
Early Psychosis ◽  
Mental Health Practitioners ◽  
First Episode ◽  
Physical And Mental Health ◽  
Early Intervention Services ◽  
Health Practitioners ◽  
Intervention Services

Abstract Background Loneliness is an important public health problem with established adverse effects on physical and mental health. Although people with psychosis often experience high levels of loneliness, relatively little is known about the relationship between loneliness and early psychosis. Potential interventions to address loneliness might be easier to implement early in the illness when social networks and social skills may be more intact than at a later stage. We investigated the views of mental health practitioners about the context and causes of loneliness in people with early psychosis, and about potential interventions. Methods Semi-structured face-to-face interviews were conducted with mental health practitioners (n = 20). Participants were purposively recruited from four early intervention services for first-episode psychosis in the UK. Interviews were transcribed verbatim and thematic analysis was conducted. Results Participants believed that the majority of service users with early psychosis experience feelings of loneliness. They often saw socially isolated and disconnected clients and believed them to be lonely, but rarely discussed loneliness explicitly in clinical interactions. A combination of symptoms, stigma and negative sense of self were believed to underpin loneliness. Participants could not identify any specific current interventions delivered by their services for tackling loneliness, but thought some routinely provided interventions, including social groups and psychological treatments, could be helpful. They favoured making a wider range of loneliness interventions available and believed that community agencies beyond mental health services should be involved to make these effective and feasible to deliver. They suggested social participation interventions without an explicit mental health focus as potentially promising and valued a co-produced approach to intervention development. Conclusions This study suggests that loneliness is not routinely discussed in early intervention services, and a targeted strategy for tackling it is lacking. Co-produced, individualised community approaches, and interventions that target symptoms, stigma and negative self-schemas might be beneficial in alleviating loneliness for people with early psychosis. Empirical research is needed to develop and test such interventions.

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