From Onset to Early Intervention Services: Research on First-Episode Psychosis

Poster A100, Thursday, October 20, 11:30 am - 1:00 pm, Le Baron

Sarah Piscitelli1, Leopoldo Cabassa2, Morgan Haselden1, Susan Essock1,2, Rufina Lee3, Lisa Dixon1,2; 1New York Psychiatric Institute, 2Columbia University, 3Silberman School of Social Work at Hunter College, City University of New York

Purpose: We aimed to identify gaps and bottlenecks contributing to lengthened duration of untreated psychosis (DUP) among individuals with first-episode psychosis (FEP) receiving specialized early intervention program (EIP) services. Materials and Methods: All locatable, clinically-stable, consenting clients (N=20) from pilot EIP and their family members (N=10) participated in qualitative interviews that explored formal (e.g., hospitalizations) and informal (e.g., clergy) help-seeking events between onset and EIP entry. Interviews were audio recorded and transcribed. Data were analyzed using grounded theory. Results: Clients were 45% female, 35% African American and 55% Hispanic; average age was 23.7 (sd=4.1). Family members were mothers (80%) and brothers (20%). Median DUP was 4.5 months. Help-seeking events included: psychiatric hospitalization (95%), outpatient mental health (65%) and primary care (40%) visits, and police contact (40%). Help-seeking delays were influenced by help-seekers’ ability to identify symptoms, stigma regarding care, and self-reliance and contributed to uncertainty regarding how to understand and respond to FEP-related experiences. Contacts with health services were critical junctures in the pathway that could reduce or increase uncertainty and expedite or delay care, thus contributing to DUP. The nature of interpersonal connections clients and families made with providers (e.g., positive or negative), quality of care received, extent of family involvement in care (e.g., partnership, alienation) and type of care transitions (e.g., care coordination, fragmentation) shaped these experiences. Conclusion: Efforts to reduce DUP should focus on reducing the uncertainty individuals with FEP and their family members face when seeking care by improving their experiences with mental health services.

Topic Area: First Episode Psychosis

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