Tindall Rachel, Simmons Magenta, Allott Kelly, Hamilton Bridget
Orygen, Parkville, VIC, Australia.
Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
Front Psychiatry. 2020 Jun 12;11:565. doi: 10.3389/fpsyt.2020.00565. eCollection 2020.
Specialized early intervention services for first-episode psychosis have been well established in many countries to meet the unique needs of this group. However, with high drop-out rates, these services would benefit from understanding the factors that influence a person's decision to engage with, or disengage from, them. No research has explored the experiences of engagement and disengagement over time, from the perspectives of the person who experienced a first-episode psychosis, their caregiver, and their clinician. This information is crucial to help services better respond to the needs of the people using them. The aim of this study was to understand what causes and maintains periods of disengagement from early intervention services for first-episode psychosis over time.
Using a longitudinal, qualitative approach, young people, their caregivers, and their clinicians were followed through their first year with an early intervention service for first-episode psychosis in Melbourne, Australia. Qualitative interviews were completed between 3-9 weeks, 4-7 months, and 11-15 months after entry to the service (or at discharge if earlier). Trajectory analysis was used to understand the data.
Qualitative interviews were conducted with 24 participants (55 interviews). Young people were aged 15-24 years, came from a variety of cultural backgrounds and had various psychotic diagnoses. Three major processes were identified that, over time, led to periods of service disengagement: a mismatch between service model and individual presentation (service mismatch), a lack of shared purpose (aimless engagement), and responses to individual circumstances (reactive disengagement).
Triangulating experiences of engagement across young people, caregivers, and clinicians allows for a comprehensive understanding of what precipitates service disengagement. This study demonstrates how early intervention services for first-episode psychosis are meeting the needs of young people and caregivers, and what areas warrant improvement. The needs of service users and patterns of disengagement vary. In turn, services must be flexible and responsive to individual circumstances. The results of this study recommend that local and international policies move away from diagnostically driven models of care, to better provide an inclusive treatment service for people with transdiagnostic mental health presentations.
在许多国家，针对首发精神病的专业早期干预服务已得到充分确立，以满足这一群体的独特需求。然而，由于脱落率较高，了解影响人们参与或退出这些服务的因素将使这些服务受益。尚无研究从首发精神病患者本人、其照顾者及其临床医生的角度，探讨随着时间推移参与和退出服务的经历。这些信息对于帮助服务机构更好地回应使用者的需求至关重要。本研究的目的是了解随着时间推移，导致首发精神病早期干预服务中断的原因及持续因素。
采用纵向定性研究方法，对澳大利亚墨尔本参与首发精神病早期干预服务的年轻人及其照顾者和临床医生进行为期一年的跟踪研究。在进入服务后的3 - 9周、4 - 7个月和11 - 15个月（或提前出院时）完成定性访谈。采用轨迹分析来理解数据。
对24名参与者进行了定性访谈（共55次访谈）。年轻人年龄在15 - 24岁之间，来自不同文化背景，患有各种精神病诊断。确定了三个主要过程，随着时间推移，这些过程导致了服务中断期：服务模式与个人表现不匹配（服务不匹配）、缺乏共同目标（无目的参与）以及对个人情况的反应（被动退出）。
综合年轻人、照顾者和临床医生的参与经历，有助于全面理解导致服务中断的因素。本研究展示了首发精神病早期干预服务如何满足年轻人和照顾者的需求，以及哪些方面需要改进。服务使用者的需求和退出模式各不相同。相应地，服务必须灵活并能应对个人情况。本研究结果建议，地方和国际政策应摒弃诊断驱动的护理模式，以便更好地为患有跨诊断心理健康问题的人群提供包容性治疗服务。
