Understanding the Pathways to Care for Individuals with or at Risk of Psychotic Disorders

Background: Delays in treatment for people experiencing early signs of psychosis are associated with poorer outcomes. However, it is not uncommon for individuals with an At-Risk Mental State (ARMS) and First Episode Psychosis (FEP) to experience lengthy delays to care and few people presenting with FEP access early intervention in psychosis (EIP) services during the prodromal stage. Pathways to Care (PtC) provides information about how individuals access services. This thesis aimed to explore PtC for individuals with ARMS and FEP, factors associated with accessing EIP at an earlier stage or psychosis, and interventions designed to reduce delays. Methods: A systematic review synthesised the available evidence on public health interventions designed to reduce delays to treatment for people with ARMS and FEP. An empirical study was conducted exploring PtC during ARMS compared to FEP, and sociodemographic characteristics associated with accessing EIP. Data were collected from a research database of de-identified clinical records. Results: Nineteen studies met the inclusion criteria for the systematic review. All studies consisted of FEP populations, with no papers investigating ARMS populations. Studies originated from various countries. Findings about the effectiveness of interventions at reducing duration of untreated psychosis (DUP) were mixed and interventions appeared to differentially impact groups. The most effective interventions appeared to be those of a longer duration and targeting multiple populations. PtC information was limited. In the empirical study, 158 individuals presenting with ARMS (n=67) and FEP (n=91) were included. There was strong evidence that ARMS patients accessing EIP were significantly younger and were less likely to be from ethnic minority backgrounds compared to FEP. ARMS patients had fewer PtC contacts, were less likely to be referred via acute services, less likely to have involuntary hospital admissions, and had reduced family involvement in their help-seeking. Conclusions: Findings regarding the effectiveness of interventions to reduce delays to treatment were inconclusive. The empirical paper highlighted sociodemographic and PtC characteristics associated with accessing EIP during ARMS compared with FEP. Further research is required to replicate these findings and investigate the effectiveness of targeted interventions to encourage and facilitate access to EIP at an earlier stage of psychosis to improve outcomes