Pathways to Care for Patients with a First Episode of Psychosis

1995 ◽  
Vol 167 (6) ◽  
pp. 770-776 ◽  
Author(s):  
Eleanor Cole ◽  
Gerard Leavey ◽  
Michael King ◽  
Eric Johnson-Sabine ◽  
Amanda Hoar
Keyword(s):  
Help Seeking ◽  
Minority Groups ◽  
Important Variable ◽  
Psychiatric Services ◽  
Pathways To Care ◽  
First Episode ◽  
Compulsory Admission ◽  
Chronic Patients ◽  
Black Patients ◽  
First Contact

BackgroundIt is reported that patients from ethnic minority groups, in particular Afro-Caribbeans, are more likely to enter less desirable pathways to psychiatric care. We aimed to determine whether ethnicity significantly affected time to presentation, type of first contact, rates of compulsory admission and police and primary care involvement, in patients with their first episode of psychosis.MethodAs part of a prospective epidemiological study, patients and their carers were interviewed using a semi-structured questionnaire to trace the various persons and agencies seen en route to their first contact with psychiatric services.ResultsWhile compulsory admission was more likely for Black patients, the excess was less striking than in previous studies. Black patients were no more likely than other patients to have police involvement. The most important factors in avoiding an adverse pathway were having a supportive family member or friend and the presence of a general practitioner to assist in gaining access to psychiatric services.ConclusionsThe routes to psychiatric services for first onset patients are different to those for chronic patients. Variables associated with social support were more important than ethnicity in determining pathways to care. Police involvement and compulsory admissions were strongly associated with the absence of GP involvement and the absence of help-seeking by a friend or relative. It may be that ethnicity becomes an important variable after the patient has come into contact with psychiatric services.

The first contact of patients with schizophrenia with psychiatric services: social factors and pathways to care in a multi-ethnic population

1999 ◽  
Vol 29 (2) ◽  
pp. 475-483 ◽  
Author(s):  
R. BURNETT ◽  
R. MALLETT ◽  
D. BHUGRA ◽  
G. HUTCHINSON ◽  
G. DER ◽  
...  
Keyword(s):  
Ethnic Groups ◽  
Psychiatric Service ◽  
Psychiatric Services ◽  
Pathways To Care ◽  
Compulsory Admission ◽  
Asian Patients ◽  
Significant Difference ◽  
African Caribbean ◽  
First Contact ◽  
First Admission

Background. African-Caribbean patients have less desirable routes of entry into the psychiatric services than other ethnic groups in Britain but this may not apply to the first contact with services.Methods. Patients' pathways to care, type of admission or referral and sectioning details were recorded for all first contact patients presenting to south London psychiatric services over a 2-year period. We also conducted a retrospective analysis of data from the Camberwell Register, comparing rates of compulsory admission between ‘Whites’ and ‘African-Caribbeans’ for first and readmissions, over a 20-year period.Results. Our first contact sample comprised 38 White, 38 African-Caribbean and 24 Asian patients with CATEGO defined broad schizophrenia. GP referral was found to be the most common mode of contact and there were no significant differences between the ethnic groups with regard to compulsory admission. Similarly, data from the Camberwell Register showed no significant difference in rates of compulsory admission between first admission White and African-Caribbean patients. However, when all readmissions were examined, African-Caribbeans were more likely to be admitted involuntarily.Conclusions. Our findings suggest that reports of less desirable routes of entry for African-Caribbean patients into the psychiatric service do not apply to their first admission but are likely to develop over time and repeated contact with the services.

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.

scholarly journals Pathways to care and ethnicity. 2: Source of referral and help-seeking

2005 ◽  
Vol 186 (4) ◽  
pp. 290-296 ◽  
Author(s):  
Craig Morgan ◽  
Rosemarie Mallett ◽  
Gerard Hutchinson ◽  
Hemant Bagalkote ◽  
Kevin Morgan ◽  
...  
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Help Seeking ◽  
Pathways To Care ◽  
First Episode ◽  
Criminal Justice Agency ◽  
Black African ◽  
African Caribbean ◽  
African Patients ◽  
Pathway To Care

BackgroundPrevious research has found that African–Caribbean and Black African patients are likely to come into contact with mental health services via more negative routes, when compared with White patients. We sought to investigate pathways to mental health care and ethnicity in a sample of patients with a first episode of psychosis drawn from two UK centres.MethodWe included all White British, other White, African–Caribbean and Black African patients with a first episode of psychosis who made contact with psychiatric services over a 2-year period and were living in defined areas. Clinical, socio-demographic and pathways to care data were collected from patients, relatives and case notes.ResultsCompared with White British patients, general practitioner referral was less frequent for both African–Caribbean and Black African patients and referral by a criminal justice agency was more common. With the exception of criminal justice referrals for Black African patients, these findings remained significant after adjusting for potential confounders.ConclusionsThese findings suggest that factors are operating during a first episode of psychosis to increase the risk that the pathway to care for Black patients will involve non-health professionals.

scholarly journals Further evidence of a cumulative effect of social disadvantage on risk of psychosis

2016 ◽  
Vol 47 (5) ◽  
pp. 913-924 ◽  
Author(s):  
S. A. Stilo ◽  
C. Gayer-Anderson ◽  
S. Beards ◽  
K. Hubbard ◽  
A. Onyejiaka ◽  
...  
Keyword(s):  
Local Population ◽  
Control Sample ◽  
Cumulative Effect ◽  
Social Disadvantage ◽  
Psychiatric Services ◽  
Cumulative Effects ◽  
First Episode ◽  
Increased Risk ◽  
First Contact

BackgroundA growing body of evidence suggests that indicators of social disadvantage are associated with an increased risk of psychosis. However, only a few studies have specifically looked at cumulative effects and long-term associations. The aims of this study are: To compare the prevalence of specific indicators of social disadvantage at, and prior to, first contact with psychiatric services in patients suffering their first episode of psychosis and in a control sample. To explore long-term associations, cumulative effects, and direction of effects.MethodWe collected information on social disadvantage from 332 patients and from 301 controls recruited from the local population in South London. Three indicators of social disadvantage in childhood and six indicators of social disadvantage in adulthood were analysed.ResultsAcross all the domains considered, cases were more likely to report social disadvantage than were controls. Compared with controls, cases were approximately two times more likely to have had a parent die and approximately three times more likely to have experienced a long-term separation from one parent before the age of 17 years. Cases were also more likely than controls to report two or more indicators of adult social disadvantage, not only at first contact with psychiatric services [odds ratio (OR) 9.5], but also at onset of psychosis (OR 8.5), 1 year pre-onset (OR 4.5), and 5 years pre-onset (OR 2.9).ConclusionsGreater numbers of indicators of current and long-term exposure are associated with progressively greater odds of psychosis. There is some evidence that social disadvantage tends to cluster and accumulate.

Pathways to care of first-admitted subjects with psychosis in South-Western France

2004 ◽  
Vol 34 (2) ◽  
pp. 267-276 ◽  
Author(s):  
A. COUGNARD ◽  
E. KALMI ◽  
A. DESAGE ◽  
D. MISDRAHI ◽  
F. ABALAN ◽  
...  
Keyword(s):  
Access To Care ◽  
Risk Behaviour ◽  
Psychotic Symptoms ◽  
Pathways To Care ◽  
First Episode ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Episode Psychosis ◽  
First Contact ◽  
First Admission

Background. A limited number of studies have assessed the pathways to care of patients with first-episode psychosis. The aim of the study was to describe the pathways to care of subjects with psychosis between onset of psychosis and first admission, and to examine the demographic and clinical factors influencing access to care.Method. Number and type of helping contacts since onset of first psychotic symptoms were assessed using multiple sources of information in 86 subjects with psychosis first-admitted in two hospitals of South-Western France. Characteristics independently associated with long delays between onset of symptoms and first helping contact, first treatment and first admission were explored using logistic regressions.Results. Twelve per cent of subjects were first admitted without any previous helping contact. The patients were seen by a median of two helpers (maximum 7). For most patients (70%), the first helping contact was a health care professional, and the same proportion of patients had a first contact with a GP or a psychiatrist. The type of first contact was not predicted by demographic or clinical characteristics. Subjects with poor pre-morbid functioning or at-risk behaviour were more likely to have a delayed access to care.Conclusions. The delay in access to care may not be totally attributed to inadequate management by health professionals, but may be a characteristic of the disease itself, at least in part independent of the organization of the health system.

The pathways to mental health care of first-episode psychosis patients: a systematic review

2010 ◽  
Vol 40 (10) ◽  
pp. 1585-1597 ◽  
Author(s):  
K. K. Anderson ◽  
R. Fuhrer ◽  
A. K. Malla
Keyword(s):  
Mental Health ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Psychotic Episode ◽  
First Psychotic Episode ◽  
Episode Psychosis ◽  
First Contact ◽  
Pathway To Care ◽  
Delay In Treatment

BackgroundAlthough there is agreement on the association between delay in treatment of psychosis and outcome, less is known regarding the pathways to care of patients suffering from a first psychotic episode. Pathways are complex, involve a diverse range of contacts, and are likely to influence delay in treatment. We conducted a systematic review on the nature and determinants of the pathway to care of patients experiencing a first psychotic episode.MethodWe searched four databases (Medline, HealthStar, EMBASE, PsycINFO) to identify articles published between 1985 and 2009. We manually searched reference lists and relevant journals and used forward citation searching to identify additional articles. Studies were included if they used an observational design to assess the pathways to care of patients with first-episode psychosis (FEP).ResultsIncluded studies (n=30) explored the first contact in the pathway and/or the referral source that led to treatment. In 13 of 21 studies, the first contact for the largest proportion of patients was a physician. However, in nine of 22 studies, the referral source for the greatest proportion of patients was emergency services. We did not find consistent results across the studies that explored the sex, socio-economic, and/or ethnic determinants of the pathway, or the impact of the pathway to care on treatment delay.ConclusionsAdditional research is needed to understand the help-seeking behavior of patients experiencing a first-episode of psychosis, service response to such contacts, and the determinants of the pathways to mental health care, to inform the provision of mental health services.

Duration of untreated psychosis and ethnicity in the ÆSOP first-onset psychosis study

2005 ◽  
Vol 36 (2) ◽  
pp. 239-247 ◽  
Author(s):  
CRAIG MORGAN ◽  
PAUL FEARON ◽  
GERARD HUTCHINSON ◽  
KWAME McKENZIE ◽  
JULIA M. LAPPIN ◽  
...  
Keyword(s):  
Mental Illness ◽  
Study Data ◽  
First Episode ◽  
Duration Of Untreated Psychosis ◽  
Treatment Delays ◽  
Black African ◽  
Black Patients ◽  
Catchment Areas ◽  
African Patients ◽  
First Contact

Background. There is a common assumption that Black patients with a psychotic mental illness experience longer treatment delays during a first episode. We sought to investigate this issue in a large cohort of patients with a first episode of psychosis.Method. All patients with a first episode of psychosis presenting to secondary mental health services within tightly defined catchment areas in south-east London and Nottingham over a 2-year period were included in the study. Data relating to duration of untreated psychosis (DUP) and clinical and sociodemographic characteristics were collected from patients, relatives and case-notes.Results. There was no evidence that African-Caribbean or Black African patients experienced longer periods of untreated psychosis than White British patients prior to first contact with services. There was evidence that Black African patients experienced shorter periods of untreated psychosis than White British patients.Conclusions. Contrary to what is commonly assumed, our study suggests that Black patients with a psychotic mental illness do not experience longer treatment delays prior to first contact with services than White British patients. This suggests that strategies to reduce treatment delays targeted specifically at Black patients will be of limited value.

scholarly journals Assessing insight in schizophrenia: East meets West

2007 ◽  
Vol 190 (3) ◽  
pp. 243-247 ◽  
Author(s):  
Balasubramanian Saravanan ◽  
K. S. Jacob ◽  
Shanthi Johnson ◽  
Martin Prince ◽  
Dinesh Bhugra ◽  
...  
Keyword(s):  
Conceptual Model ◽  
Help Seeking ◽  
South India ◽  
Explanatory Models ◽  
Psychiatric Services ◽  
Culturally Specific ◽  
Clinical Variables ◽  
First Contact ◽  
The Relationship ◽  
Supernatural Explanations

BackgroundLack of insight has been observed in people with schizophrenia across cultures but assessment of insight must take into account prevailing illness models.AimsTo determine whether culturally specific and Western biomedical interpretations of insight and psychosis can be reconciled.MethodPatients with schizophrenia (n=131) were assessed during their first contact with psychiatric services in Vellore, South India. Patients' explanatory models, psychopathology and insight were investigated using a standard schedule translated into Tamil.ResultsSupernatural explanations of symptoms were frequent. Some insight dimensions were weakly associated (inversely) with severity of symptoms whereas preserved insight was associated with anxiety, help-seeking and perception of change. Willingness to attribute symptoms to disease, in others and in one's self, but not to supernatural forces was strongly associated with insight.ConclusionsThe relationship between insight, awareness of illness and other clinical variables is similar in South India to elsewhere. However, the assessment of insight might have failed to capture locally accepted explanatory frameworks. An inclusive conceptual model which emphasises help-seeking is recommended.

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