Pathways to Care in First Episode Psychosis (FEP) A survey of GPs Cambridge 13.10. 2007

1. Pathways to Care in First Episode Psychosis (FEP) A survey of GPsCambridge 13.10. 2007 Dr Mamdouh EL-Adl, Dr John Burke & Karen Little, Northamptonshire Healthcare NHS Trust, UK.

2. Overview • Introduction • Study design & results • Conclusion • Thank you

3. Introduction

4. Treatment delay in FEP • FEP studies provide a compelling evidence that treatment delay is a hallmark of early psychosis. (Helgason 1990; Johnstone et al 1986; Loebel et al 1992) • The Northwick Park study focused on pathways to initial treatment & highlighted delay as a major problem. (Johnstone et al 1986)

5. New terms • FEP: First Episode Psychosis • DUP: Duration of Untreated Psychosis. From onset of positive psychotic symptoms until initiation of treatment. • DUI: Duration of Untreated Illness. From onset of prodrome to initiation of treatment. (Compton & Esterberg, 2005)

6. Average DUP • FEP (First Episode Psychosis) studies: Average DUP i.e. duration between onset & first effective treatment is one year or more. (McGlashan, 1998; Compton & Esterberg, 2005)

7. Long DUP/DUI is undesirable, Why? • Early treatment helps: -  suffering. (Ho et al, 2003) -  risks. (Wyatt et al, 1998; Larsen et al 1998) 2. Shorter DUP is associated with better clinical response. (Perkins et al, 2004) 3. Early results suggested that EIP service is more cost effective. (Mihalopoulos et al, 1999)

8. In UK • In 2001 the UK Department of Health put a plan to establish a network of Early Intervention Services across UK. (DOH, 2001) • In UK, most GPs see 1–2 new people with FEP/year. (Shires & Lester, 2004)

9. Pathway to care in early psychosis • “Pathway to care” is a helpful concept. (Gallo et al 1995a; Goldberg & Huxley 1992) • Understanding & Examining these pathways for individuals with an emergent psychosis is likely to help: 1. our understanding of barriers to care. 2. Develop better intervention strategies.

10. A Driver without a Navigator

11. Selective Filters • GPs are considered to be: 1. The gate keepers to secondary care 2. Selectively permeable filters to accessing secondary care. • It was therefore found very important to study the primary care experience with FEPbefore developing the local EIP service.

12. GP filtering

13. The Study

14. Aims of the study: • To study the local primary care experience with FEP prior to developing the local EIP service. • To strengthen the interface with primary care.

15. Method: • A confidential questionnaire developed by M EL-Adl & approved by 10 clinicians. • Questionnaires sent by CGST (Clinical Governance Support Team) to all GPs in Northamptonshire (284). • Responses collected & analysed by CGST.

16. Northamptonshire • Population: 650,000 – 700,000 • Main towns: Northampton, Kettering, Corby, Wellingborough, Daventry. • Adult psychiatric service: - Medical staff : 16 consultants + 10 middle grade + 15 SHO. - Beds: 2 Acute inpatient units (80 beds)

17. Service Model: • Primary Care: well developed • Secondary Care: - Acute: NGH (Northampton General Hospital) KGH (Kettering General Hospital) - Mental Health: Adult, Elderly, L D, Child, Rehabilitation, Drug & Alcohol.

18. Results

19. Response rate:

20. GPs starting treatment before referring to psychiatric service

21. GPs referral trends

26. Number of FEP cases seen by GPs over last 12 months

29. Table 11: Type of service preferred byGPs

30. Table 12: GPs experience of main causes for delayed referral to psychiatric care

31. Conclusion • EIP service developers could benefit considerably from studying primary care experience. • GPs need to be adequately informed about EIP. • Improving public awareness & attitude towards mental illness is essential.

32. Acknowledgement • Thanks to Primary Care colleagues who participated in this study. • Thanks to all colleagues who offered their support while planning for this project.

33. Together for a better future

34. Thank you