178.1 A Qualitative Study of the Influences on the Pathway to Care for Individuals Experiencing Early Psychosis

Abstract

Background: We aimed to identify gaps and bottlenecks contributing to lengthened duration of untreated psychosis (DUP) among individuals with frst-episode psychosis (FEP) receiving specialized RAISE Connection early intervention program (EIP) services. Methods: All locatable, clinically stable, consenting RAISE Connection clients (N = 20) 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 (85%) and primary care (30%) visits, and police contact (25%). Help-seeking delays were infuenced 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. Some attributed the symptoms of psychosis to drug use. Others described how they frst did not think the symptoms were due to a mental illness requiring professional treatment. Contacts with health services were critical junctures in the pathway that could expedite or delay care. 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 and alienation) and type of care transitions (e.g., care coordination and fragmentation) shaped these experiences. High quality of care was described as clients and family members getting accurate diagnostic information and providers involving them in discussions about appropriate treatment options. Low quality of care was described as care that did not provide clients and family members with clear information about treatment options and side effects and resulted, in some instances, in not getting any mental health care or referrals from providers. Positive care transitions were characterized as having providers that were involved in care coordination by identifying appropriate services and referrals and helping clients and family members make these treatment connections. Negative care transitions did not provide these supports and left patients and families without clear options for follow-up care. Conclusion: Efforts to reduce DUP need to address challenges in symptom attribution, stigma and self-reliance that individuals with FEP and their family members face when considering help seeking and pursuing treatment. The quality and experience of health services must be improved. We have created a clinician toolkit to meet these goals. Supported by NIMH HSN271200900020C.