Pathways to care in at-risk mental states and first episode psychosis

Allan, Sophie (2020) Pathways to care in at-risk mental states and first episode psychosis. Doctoral thesis, University of East Anglia.

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Background: People with early psychotic symptoms often experience treatment delays, which can exacerbate distress and lead to poorer outcomes, with significant personal and financial costs. Delays can occur in both people with an At-Risk Mental State

(ARMS) for psychosis and in First Episode Psychosis (FEP). The thesis aimed to explore treatment delays and help-seeking using the paradigm of Pathways to Care (PtC).

Methods: A systematic review of PtC in ARMS was conducted which synthesised quantitative and qualitative studies. A qualitative study was carried out exploring PtC in participants with ARMS and FEP using semi-structured one-to-one interviews, analysed using thematic analysis.

Results: Ten studies met inclusion criteria for the systematic review. There was significant heterogeneity, with varying countries, screening tools and PtC instruments adopted. Overall, mental health professionals and General Practitioners (GPs) were found to have a key role in PtC, with family also identified as important in several studies. In the empirical study, eleven participants were interviewed about their experiences of PtC and barriers and facilitators to earlier help-seeking. Many participants had complex PtC and difficult experiences. Themes identified for experiences of PtC were “onset” and “unheard”; for barriers and facilitators themes were “gate keepers”, “personal” and “societal”. Overall the empirical paper also identified the key role of GPs and family, as well as stigma and culture.

Conclusions: The role of both GPs and family in help-seeking in both ARMS and FEP renders the need for service-level and public health interventions to raise awareness of psychotic experiences and available services. These may have the potential to shorten the PtC and improve outcomes. Clinical implications, including for GPs and Early Intervention in Psychosis services are given. Further research is required to triangulate and extend the findings.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Chris White
Date Deposited: 08 Mar 2021 10:32
Last Modified: 08 Mar 2021 10:32


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