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BMC Psychiatry
Published in: BMC Psychiatry 1/2015

Open Access 01-12-2015 | Research article

Evaluation of a community awareness programme to reduce delays in referrals to early intervention services and enhance early detection of psychosis

Authors: Brynmor Lloyd-Evans, Angela Sweeney, Mark Hinton, Nicola Morant, Stephen Pilling, Judy Leibowitz, Helen Killaspy, Sanna Tanskanen, Jonathan Totman, Jessica Armstrong, Sonia Johnson

Published in: BMC Psychiatry | Issue 1/2015

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Abstract

Background

Reducing treatment delay and coercive pathways to care are accepted aims for Early Intervention Services (EIS) for people experiencing first episode psychosis but how to achieve this is unclear. A one-year community awareness programme was implemented in a London EIS team, targeting staff in non-health service community organisations. The programme comprised psycho-educational workshops and EIS link workers, and offering direct referral routes to EIS. Its feasibility and its impact on duration of untreated psychosis and pathways to EIS were evaluated.

Methods

Evaluation comprised: pre and post questionnaires with workshop participants assessing knowledge and attitudes to psychosis and mental health services; and a comparison of new service users’ “service DUP”(time from first psychotic symptom to first contact with EIS) and pathways to care in the intervention year and preceding year. Focus groups sought stakeholders’ views regarding the benefits and limitations of the programme and what else might promote help-seeking.

Results

41 workshops at 36 community organisations were attended by 367 staff. 19 follow up workshops were conducted and 16 services were allocated an EIS link worker. Participants’ knowledge and attitudes to psychosis and attitudes to mental health services improved significantly following workshops. In the year of the intervention, only 6 of 110 new service users reached EIS directly via community organisations. For all new referrals accepted by EIS, in the intervention year compared to the previous year, there was no difference in mean or median service DUP. A clear impact on pathways to care could not be discerned. Stakeholders suggested that barriers to referral remained. These included: uncertainty about the signs of early psychosis, disengagement by young people when becoming unwell, and worries about stigma or coercive treatment from mental health services. More general, youth focused, mental health services were proposed.

Conclusions

The community awareness programme did not reduce treatment delays for people experiencing first episode psychosis. Further research is needed regarding effective means to reduce duration of untreated psychosis. Although EIS services are guided to promote access through community engagement, this may not be an effective use of their limited resources.

Trial registration

Current Controlled Trial ISRCTN98260910 Registered 19th May 2010.
Appendix
Available only for authorised users
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Metadata
Title
Evaluation of a community awareness programme to reduce delays in referrals to early intervention services and enhance early detection of psychosis
Authors
Brynmor Lloyd-Evans
Angela Sweeney
Mark Hinton
Nicola Morant
Stephen Pilling
Judy Leibowitz
Helen Killaspy
Sanna Tanskanen
Jonathan Totman
Jessica Armstrong
Sonia Johnson
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-015-0485-y

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