Abstract
PurposeEarly Intervention Psychosis [EIP] services have gained traction internationally, but are currently undergoing various forms of reconfiguration. In England, such services are now mandated to ensure 50% of accepted referrals commence care within 14 days, but no empirical evidence exists. We sought to estimate waiting times to EIP services in a large, representative epidemiological cohort in England, and investigate possible reasons for any variation.MethodsWe estimated median waiting time from referral to acceptance by EIP services and investigated whether this varied by clinical, demographic or neighbourhood-level factors, amongst 798 participants, 16–35 years old, presenting to six EIP services over 3.5 years in a defined catchment area serving 2.5 million people. We used parametric survival analysis to inspect variation in waiting times (in days).ResultsMedian waiting time was 15 days (interquartile range 7–30), although this varied across services (p < 0.01). Waiting times increased over the case ascertainment period by an average of 4.3 days (95% CI 1.3, 6.2; p < 0.01). Longer waiting times were associated with greater diagnostic uncertainty, indexed by an organic presentation (+ 9.1 days; 95% CI 1.9, 16.6; p < 0.01), polysubstance abuse (+ 2.6; 0.6, 3.9; p < 0.01), absence of psychotic disorder (+1.8; −0.1, 3.0; p = 0.05) and insidious onset (+1.8; −0.1, 3.0; p = 0.06). Waiting times did not vary by most demographic or neighbourhood-level characteristics.ConclusionsEIP services operate close to new waiting time standards in England, with little systematic variation by sociodemographic position. However, waiting times increased over the study period, coinciding with substantial service reorganisation. Longer waiting times associated with greater diagnostic uncertainty highlight opportunities to reduce delays in certain clinical groups at initial referral.
Highlights
Intervention in Psychosis [EIP] services offer a multidisciplinary package of care for people experiencing their first episode of psychosis, underpinned by evidence that reducing the duration of untreated psychosis [DUP] leads to better clinical, functional and social outcomes for people experiencing psychosis [1]
Longer waiting times were associated with greater diagnostic uncertainty, indexed by an organic presentation (+ 9.1 days; 95% CI 1.9, 16.6; p < 0.01), polysubstance abuse (+ 2.6; 0.6, 3.9; p < 0.01), absence of psychotic disorder (+1.8; −0.1, 3.0; p = 0.05) and insidious onset (+1.8; −0.1, 3.0; p = 0.06)
In the first investigation of waiting times in EIP services since the introduction of national guidelines to commence treatment within 2 weeks of referral for at least 50% of clients [12], our data indicated that services in a large region in the East of England were already operating close to this target (50% of clients accepted onto EIP caseloads within 15 days)
Summary
Intervention in Psychosis [EIP] services offer a multidisciplinary package of care for people experiencing their first episode of psychosis, underpinned by evidence that reducing the duration of untreated psychosis [DUP] leads to better clinical, functional and social outcomes for people experiencing psychosis [1]. In April 2016, new “Access and Waiting Time Standard” came into force [12], mandating that at least half of all referrals to EIP services should commence a NICE-concordant package of care for psychosis within two weeks of referral [13], with a commitment to raise this standard to 60% by 2020/21. Efforts to reduce EIP waiting times are concomitant with shortening the duration of untreated psychosis [DUP] in people in their first episode of psychosis [FEP], since delays within the mental health system contribute substantially to overall DUP [14, 15]. No empirical evidence exists about the current magnitude of waiting times in EIP services, or whether these vary by clinical, demographic, environmental or service-level factors
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