Women's Care in First-Episode Psychosis: Clinicians' Perspectives on Service Provision

Abstract

Background: Early intervention in Psychosis (EIP) services are vital in reducing the long-term impact of first-episode psychosis (FEP). However, women with FEP encounter unique biological, social, and systemic challenges that may delay diagnosis, hinder access to care, and affect treatment engagement. Aims: This study explores clinicians' perspectives on the sex-specific needs of women with FEP, focusing on hormonal influences, caregiving responsibilities, stigma, and systemic barriers to care within EIP services. Method: A qualitative design was employed, utilising semi-structured interviews with 20 clinicians from EIP and adult mental health services in Dublin, Ireland. Reflective Thematic Analysis was used to identify key themes, with an inductive constructivist approach underpinning the analysis. Results: Four key themes: (1) Sex differences in presentation, with women showing later onset, higher emotional distress, and lower rates of substance-induced psychosis; (2) Hormonal interactions, highlighting the impact of menstruation, pregnancy, and menopause on symptomatology and treatment response; (3) Shame and adjustment, with internalised stigma, delayed help-seeking, and disruption of social roles; (4) Barriers to care, including caregiving responsibilities and inflexible service models. Clinicians emphasised the need for integrated, sex-sensitive and trauma-informed care, as well as improved collaboration between psychiatry, gynaecology and endocrinology. Conclusions: Women with FEP face multifaceted barriers to accessing and engaging with EIP services. Implementing clinician recommendations, namely flexible and integrated care, trauma-informed and sex-sensitive approaches, and robust cross-disciplinary collaboration, is vital for improving outcomes. Future research should incorporate service user perspectives to further refine inclusive and effective EIP pathways for women.