Intersecting disadvantage: Unpacking poor outcomes within early intervention in psychosis services

Jones, Nev; Godzikovskaya, Julia; Zhao, Zhen; Vasquez, Anthony; Gilbert, Al; Davidson, Larry

doi:10.1111/eip.12508

Cited by 22 publications

(17 citation statements)

References 28 publications

(29 reference statements)

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“…These insights may facilitate considerations for specific forms of service need. Certain differences between profiles may reflect background disadvantages such as trauma, socio-economic adversity and systematic racism (Jones et al, 2017) impacting neuro development, engagement (Doyle et al, 2014) and clinical decision-making, particularly in regard to use of mental health act and hospitalisation. The disparity between profiles 1 and 3 may relate to decisions made by services to refer someone to inpatient instead of a crisis team, or the referral/acceptance criteria of a service which may prioritise certain types of patients.…”

Section: Discussionmentioning

confidence: 99%

Profiles and trajectories of mental health service utilisation during early intervention in psychosis

O’Driscoll

Shaikh

Finamore

et al. 2021

Schizophrenia Research

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Background Early intervention in psychosis services (EIS) support individuals experiencing a first episode of psychosis. Support required will vary in response to the remittance and reoccurrence of symptoms, including relapses. Characterising individuals who will need more intensive support can inform care planning. This study explores service utilisation profiles and their trajectories of service use in a sample of individuals referred to EIS. MethodWe analysed service utilisation during the 3 years following referral to EIS (n = 2363) in West London between 2011 and 2020. Mental health service utilisation data were submitted to model-based clustering. Latent growth models were then estimated for identified profiles. Profiles were compared regarding clinical and demographic characteristics and onward pathways of care.Results: Analyses revealed 5 profiles of individuals attending EIS based on their service utilisation over 3 years. 55.5% of the sample were members of a low utilisation and less clinically severe profile. The distinct service use patterns of these profiles were associated with Health of the Nations Outcome Scale scores at treatment initiation (at total, subscale, and individual item level), along with age and gender. These patterns of use were also associated with onward care and ethnicity.Conclusions: Profiles and trajectories of service utilisation call for development of integrated care pathways and use of more personalised interventions. Services should consider patient symptoms and characteristics when making clinical decisions informing the provision of care. The profiles represent typical patterns of service use, and identifying factors associated with these subgroups might help optimise EIS support.

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Section: Discussionmentioning

confidence: 99%

Profiles and trajectories of mental health service utilisation during early intervention in psychosis

O’Driscoll

Shaikh

Finamore

et al. 2021

Schizophrenia Research

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“…Reasons for passive engagement were commonly related to practical (e.g., financial, transport), psychological (e.g., residual symptoms, side-effects from medications) and support (caregiver involvement and capacity to actively provided support) factors. This is of particular interest as structural adversity, trauma and poor community support are some of the key reasons for poor treatment response and outcomes in this population [18]. In a society with increasing inequity and diversity, ensuring that flexible and assertive services can be offered to these individuals is of upmost importance.…”

Section: Discussionmentioning

confidence: 99%

The missing voice of engagement: an exploratory study from the perspectives of case-managers at an early intervention service for first-episode psychosis

et al. 2019

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BackgroundA key component of case-management in early intervention services for first-episode psychosis is engaging a person with the service and building a relationship from which therapy and treatment can be facilitated. The aim of this study was to understand how case-managers at an early intervention service experience the process of engagement and working with varying levels of attendance and participation.MethodsQualitative interviews were conducted with the case-managers of nine young people treated at an early intervention service for first-episode psychosis within 6 months of treatment entry. Interviews discussed the process of working with the young person and factors that influenced service engagement. Interviews were analyzed using thematic analysis.ResultsCase-managers described a range of influences on engagement which were grouped under the themes: young person and caregiver influences on engagement, case-manager influences on engagement, and influences of the early intervention service system on engagement. The experience of engagement was described as relational, however it occurred in the context of broader influences, some of which were unable to be changed or challenged by the case-manager (e.g., resource allocation, models of treatment, young person demographics).ConclusionThis study illustrates the challenges that case-managers face when working with young people with first-episode psychosis, and the direct influence this has on engagement with treatment. Understanding these challenges and addressing them in policy and service design may lead to improvements in young peoples’ recovery from first-episode psychosis and increase case-manager job satisfaction.

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“…By understanding the ontico-ontological difference as a relationship— a relationship between material conditions and phenomenological structures, between houselessness and existential homelessness—we can develop new ways of conducting hybrid phenomenological and social justice work on the ground. Potential interdisciplinary allies in doing so include the structural competency movement (e.g., Jones et al, 2017; Metzl & Hansen, 2014), which focuses on societal-institutional disparities, as well as on the biopsychosocial social defeat hypothesis (Selten, van der Ven, Rutten, & Cantor-Graae, 2013), which highlights social determinants in challenging conventional “social drift” lore. Interdisciplinary collaborations with these broader movements might enhance our phenomenological–existential tools for investigating how extreme states are existentially called upon by extreme ontic conditions of the world.…”

Section: Social Justice Implicationsmentioning

confidence: 99%

Extreme States and Extreme Conditions: On Homelessness and the Ontico-ontological Difference

Kamens

2018

Journal of Humanistic Psychology

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This article briefly examines the intersections between extreme psychological states and extreme structural conditions of the world. Drawing on the work of Martin Heidegger and Louis Sass, I argue that heightened focus on ontological–existential matters during extreme states often comprises (rather than eschews) a meaningful and humanistic response to extreme worldly conditions. At the center of this article are the stories of two persons who offered generosity and hospitality toward the everyday community of other humans while experiencing both extreme psychological states and extreme structural conditions.

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Intersecting disadvantage: Unpacking poor outcomes within early intervention in psychosis services

Cited by 22 publications

References 28 publications

Profiles and trajectories of mental health service utilisation during early intervention in psychosis

Profiles and trajectories of mental health service utilisation during early intervention in psychosis

The missing voice of engagement: an exploratory study from the perspectives of case-managers at an early intervention service for first-episode psychosis

Extreme States and Extreme Conditions: On Homelessness and the Ontico-ontological Difference

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