Care pathways, DUP and access to early intervention in psychosis - - PowerPoint PPT Presentation

13/11/2015

Care pathways, DUP and access to early intervention in psychosis services. What’s good, what’s bad and how can we make it better?

Max Birchwood

Did the introduction of EI teams reduce DUP in UK?

Birmingham 5 teams

(Birchwood/Lester)

Lancashire + Wirral 5 teams

(Marshall/Lewis/Sharma)

East Anglia 4 teams

(Jones/Fowler)

Cornwall 2 teams

(Amos/Harrison)

The National/SUPER EDEN sites

Is there a critical period for DUP?

N=1027, UK National EDEN study Marshall et al, in submission

So have EI teams sorted the DUP/ treatment delay problem?

Still late intervention for ~ 1/3

DUP in UK (the National EDEN study)

Let’s blame the GPs?

Duration of Untreated Psychosis – component delays

Duration of Untreated Psychosis

Onset

Treatment Help seeking delay

First help-seeking

Delay in first ref to MHS

Referral to MHS

Delay within MHS Treatment Delay in ref to EIS Ref to EIS

1/3 still have long DUP (> 6 months)

Birmingham EIS: over 20 years old, but still long DUP for many

Why is DUP still so long?

1/3 still have long DUP (> 6 months) Mostly accounted for by delays within mental health services

DUP > 6months characterised by…

• More severe positive symptoms and general

psychopathology at entry into Early Intervention Services

• Younger age of onset (average 19 vs 21)
• 41% under 18yrs at onset (majority

between ages of 16 – 18)

Impact of the first mental health contact

CAMHS/CMHTs linked to longer DUP

Premature discharge from CMHT common lengthens DUP Why does first contact with CMHT/CAMHS prolong DUP?

Delays access to EIS, which prolongs DUP Why?

How short do delays in mental health services etc, need to be?

The position of EIS in care pathway critical

Generic access pathways prolong DUP

Can DUP be reduced in the UK context?

Interventions to reduce DUP: what works?

• Review - Lloyd-Evans et. al., 2011, BJPsych
• Multi-focused initiatives (eg TIPS) – mixed results
• GP focused initiatives (LEOCAT (London), REDIRECT

(Birmingham) found no significant effect on DUP

• EIS have reduced DUP (N EDEN)

“Successful interventions to target treatment delays, therefore, will require greater understanding of the context within which they occur” Lloyd-Evans, et al 2011.

Birmingham pathways study: A quasi-experimental

pilot trial

Psychosis awareness campaign Care pathway change (16-25 service)

Psychosis awareness Campaign

Launched January 7th 2012 in local supermarkets

• Patient and public involvement
• Posters, postcards & ‘give-aways’
• Bus/street advertising
• Mail drops
• Special events (flashmobs; music and art

exhibitions)

• Community events
• Regular spots in community press and on

community websites;

• Direct link to Psychosis page on website
• Information line

Reducing delay in the first treatment of psychosis in Birmingham, UK

Information line:

A dedicated information line for anyone wanting further details about psychosis Manned by trained Advisors

0121 301 5858

Daily – 1 – 4.30

Reducing delay in the first treatment of psychosis in Birmingham, UK

www.youthspace.me/psychosis

Reducing delay in the first treatment of psychosis in Birmingham, UK

Primary outcome:

DUP

Secondary outcomes:

Help-seeking delay; Delay in MH services

Reducing delay in the first treatment of psychosis in Birmingham, UK

DUP and components in target and control areas.

Relative risk for the reduction in DUP for South = 0.736 (95% CI 0.350 to 0.893; p=.0039)

Conclusions

• EIS can reduce treatment delay in MHS and

DUP, but lots still to do

• Access to EIS a critical factor in stopping the

DUP clock

• But DUP clock ticks while YP tries to access EIS
• CMHT/CAMHS tend to prolong DUP as YP

disengages or psychosis not recognised.

• Care pathway to EIS crucial: ‘whole youth

pathway’ can help.

Thank you m.j.birchwood@warwick.ac.uk