一项旨在减少转介至早期干预服务的延迟并加强精神病早期检测的社区意识计划的评估。
Evaluation of a community awareness programme to reduce delays in referrals to early intervention services and enhance early detection of psychosis.
作者信息
Lloyd-Evans Brynmor, Sweeney Angela, Hinton Mark, Morant Nicola, Pilling Stephen, Leibowitz Judy, Killaspy Helen, Tanskanen Sanna, Totman Jonathan, Armstrong Jessica, Johnson Sonia
机构信息
Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, W1W 7EJ, London, United Kingdom.
Camden and Islington NHS Foundation Trust, Early Intervention Service, 4 Greenland Road, Camden, NW1, London, United Kingdom.
出版信息
BMC Psychiatry. 2015 May 2;15:98. doi: 10.1186/s12888-015-0485-y.
BACKGROUND
Reducing treatment delay and coercive pathways to care are accepted aims for Early Intervention Services (EIS) for people experiencing first episode psychosis but how to achieve this is unclear. A one-year community awareness programme was implemented in a London EIS team, targeting staff in non-health service community organisations. The programme comprised psycho-educational workshops and EIS link workers, and offering direct referral routes to EIS. Its feasibility and its impact on duration of untreated psychosis and pathways to EIS were evaluated.
METHODS
Evaluation comprised: pre and post questionnaires with workshop participants assessing knowledge and attitudes to psychosis and mental health services; and a comparison of new service users' "service DUP"(time from first psychotic symptom to first contact with EIS) and pathways to care in the intervention year and preceding year. Focus groups sought stakeholders' views regarding the benefits and limitations of the programme and what else might promote help-seeking.
RESULTS
41 workshops at 36 community organisations were attended by 367 staff. 19 follow up workshops were conducted and 16 services were allocated an EIS link worker. Participants' knowledge and attitudes to psychosis and attitudes to mental health services improved significantly following workshops. In the year of the intervention, only 6 of 110 new service users reached EIS directly via community organisations. For all new referrals accepted by EIS, in the intervention year compared to the previous year, there was no difference in mean or median service DUP. A clear impact on pathways to care could not be discerned. Stakeholders suggested that barriers to referral remained. These included: uncertainty about the signs of early psychosis, disengagement by young people when becoming unwell, and worries about stigma or coercive treatment from mental health services. More general, youth focused, mental health services were proposed.
CONCLUSIONS
The community awareness programme did not reduce treatment delays for people experiencing first episode psychosis. Further research is needed regarding effective means to reduce duration of untreated psychosis. Although EIS services are guided to promote access through community engagement, this may not be an effective use of their limited resources.
TRIAL REGISTRATION
Current Controlled Trial ISRCTN98260910 Registered 19th May 2010.
背景
减少治疗延迟以及避免强制就医途径是针对首次发作精神病患者的早期干预服务（EIS）公认的目标，但如何实现这一目标尚不清楚。伦敦一个EIS团队实施了一项为期一年的社区宣传计划，目标是针对非卫生服务社区组织的工作人员。该计划包括心理教育工作坊和EIS联络人员，并提供直接转介至EIS的途径。对其可行性以及对未治疗精神病持续时间和EIS就医途径的影响进行了评估。
方法
评估包括：对工作坊参与者进行前后问卷调查，评估其对精神病和心理健康服务的知识及态度；比较新服务使用者的“服务延误期”（从首次精神病症状出现到首次接触EIS的时间）以及干预年份和前一年的就医途径。焦点小组征求利益相关者对该计划的益处和局限性以及其他可能促进寻求帮助的因素的看法。
结果
36个社区组织举办了41场工作坊，367名工作人员参加。举办了19场后续工作坊，并为16个服务机构分配了一名EIS联络人员。工作坊后，参与者对精神病的知识和态度以及对心理健康服务的态度有了显著改善。在干预年份，110名新服务使用者中只有6人通过社区组织直接转介至EIS。对于EIS接受的所有新转介病例，与上一年相比，干预年份的平均或中位服务延误期没有差异。对就医途径没有明显影响。利益相关者表示转介障碍仍然存在。这些障碍包括：对早期精神病症状的不确定性、年轻人发病时的脱离接触以及对心理健康服务污名化或强制治疗的担忧。有人提议提供更普遍、以青年为重点的心理健康服务。
结论
社区宣传计划并未减少首次发作精神病患者的治疗延迟。需要进一步研究减少未治疗精神病持续时间的有效方法。尽管EIS服务旨在通过社区参与促进就医，但这可能不是对其有限资源的有效利用。
试验注册
当前对照试验ISRCTN98260910于2010年5月19日注册。
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