Management of early psychosis in a generic adult mental health service

Objective: To evaluate current practice at a generic adult mental health service, St Vincent's Mental Health Service (SVMHS) in relation to management of patients with early psychosis. A further aim was to compare treatment of early psychosis patients within this generic service with management of a similar group in a specialized early psychosis service. Method: A case file audit of all patients identified as having early psychosis (within the first 2 years of treatment) was undertaken using a standardized audit tool. Variables including proportion of early psychosis admitted as inpatients to the psychiatric unit, average length of stay (LOS), use of seclusion, involvement of police in admission process, mean neuroleptic dose and estimated duration of untreated psychosis (DUP) were studied. Results of this audit were then compared with published evaluative data from the Early Psychosis Prevention and Intervention Centre (EPPIC), a service specifically catering for young people with early psychosis (within the first 18 months of treatment). Results: Data were collected on 62 of 68 patients identified as having early psychosis. Within the generic service, mean DUP was found to be about 15 months, a high proportion (81%) of patients were admitted and secluded (22% of those admitted), average length of stay was 46.5 days and use of police in the admission process was also high (40% of those admitted). This compares unfavourably with the EPPIC data of mean DUP of just over 6 months, 64.1 % of patients admitted, 10.3% secluded, average LOS 12.9 days, and police involved in 3.8% of admissions. Conclusions: We believe that practice at SVMHS in relation to early psychosis patients is fairly typical of management of these patients within generic services as a whole. These services tend to focus on the needs of the majority of their patients, those with chronic schizophrenia, rather than the small group of patients with early psychosis (who make up about 8% of current case-load at SVMHS). Failure to assertively assess and follow-up young people with early psychosis may contribute to long DUPs, which may in turn result in patients being more disturbed at time of initial treatment, thus requiring inpatient treatment and longer length of stay. Additionally, staff at generic services may not feel confident in managing early psychosis patients and may be unaware of the special needs of this patient group. These preliminary data suggest that generic services are not optimal for treatment of early psychosis patients and that treatment of early psychosis within them is not cost-effective.