Service user and carer experiences of seeking help for a first episode of psychosis: a UK qualitative study
نویسندگان
چکیده
BACKGROUND Long duration of untreated psychosis (DUP) is associated with poor outcomes and low quality of life at first contact with mental health services. However, long DUP is common. In order to inform initiatives to reduce DUP, we investigated service users' and carers' experiences of the onset of psychosis and help-seeking in two multicultural, inner London boroughs and the roles of participants' social networks in their pathways to care. METHOD In-depth interviews were conducted with service users and carers from an early intervention service in North London, purposively sampled to achieve diversity in sociodemographic characteristics and DUP and to include service users in contact with community organisations during illness onset. Interviews covered respondents' understanding of and reaction to the onset of psychosis, their help-seeking attempts and the reactions of social networks and health services. Thematic analysis of interview transcripts was conducted. RESULTS Multiple barriers to prompt treatment included not attributing problems to psychosis, worries about the stigma of mental illness and service contact, not knowing where to get help and unhelpful service responses. Help was often not sought until crisis point, despite considerable prior distress. The person experiencing symptoms was often the last to recognise them as mental illness. In an urban UK setting, where involved, workers in non-health community organisations were frequently willing to assist help-seeking but often lacked skills, time or knowledge to do so. CONCLUSION Even modest periods of untreated psychosis cause distress and disruption to individuals and their families. Early intervention services should prioritise early detection. Initiatives aimed at reducing DUP may succeed not by promoting swift service response alone, but also by targeting delays in initial help-seeking. Our study suggests that strategies for doing this may include addressing the stigma associated with psychosis and community education regarding symptoms and services, targeting not only young people developing illness but also a range of people in their networks, including staff in educational and community organisations. Initiatives to enhance the effective involvement of staff in community organisations working with young people in promoting help-seeking merit research.
منابع مشابه
"There are too many steps before you get to where you need to be": help-seeking by patients with first-episode psychosis.
BACKGROUND There has been substantial research on pathways to care in first-episode psychosis (FEP); however, few studies have used a qualitative research paradigm or have been done from the perspective of the person experiencing the psychotic episode. OBJECTIVE We sought to describe the experiences of patients with FEP on their pathway to care and to identify factors that help or hinder help...
متن کاملMental health-related stigma and pathways to care for people at risk of psychotic disorders or experiencing first-episode psychosis: a systematic review.
BACKGROUND Stigma associated with mental illness can delay or prevent help-seeking and service contact. Stigma-related influences on pathways to care in the early stages of psychotic disorders have not been systematically examined. METHOD This review systematically assessed findings from qualitative, quantitative and mixed-methods research studies on the relationship between stigma and pathwa...
متن کاملPosttraumatic growth following a first episode of psychosis: a mixed methods research protocol using a convergent design
BACKGROUND The suffering people experience following a first episode of psychosis is great, and has been well-investigated. Conversely, potential positive outcomes following a first episode of psychosis have been under-investigated. One such outcome that may result from a first episode of psychosis is posttraumatic growth, or a positive aftermath following the trauma of a first psychotic episod...
متن کاملCaregiving in first-episode psychosis: social characteristics associated with perceived 'burden' and associations with compulsory treatment.
AIMS High incidence of psychosis and compulsory treatment within black and minority ethnic (BME) groups in the UK remain a concern. Psychosis has an impact on families and family involvement is important in predicting compulsory treatment. We therefore aimed to report the levels and predictors of caregiver burden in first-episode psychosis, in white British, and BME groups of carers, and invest...
متن کاملExpressed emotion at first-episode psychosis: investigating a carer appraisal model.
BACKGROUND Even at the first episode of psychosis, high expressed emotion (EE) characterises over half of patient-carer relationships. This study compared a carer appraisal model of EE with the ability of illness factors to predict EE at the first episode. AIMS To investigate the utility of a carer appraisal model of EE in first-episode psychosis. METHOD We compared high- and low-EE carers ...
متن کامل