The pathways to psychiatric care: a cross-cultural study

Gater, Richard; Sousa, De B. Almeida E.; Barrientos, Guido A.; Caraveo, Jorge; Chandrashekar, C. R.; Dhadphale, M; Goldberg, David; Kathiri, A. H. Al; Mubbashar, Malik H.; Silhan, K.; Thong, Denny; Torres-Gonzales, Francisco; Sartorius, Norman

doi:10.1017/s003329170002239x

Cited by 259 publications

(255 citation statements)

References 4 publications

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“…We therefore used an amended version of the encounter form from Gater et al 75 in which an interview and coding protocol were created to ensure consistency between researchers (see Appendix 8). As with the NOS, all medical notes and correspondence are collated into a timeline detailing the patient's journey to psychiatric care.…”

Section: Illness Encounters and Pathways To Carementioning

confidence: 99%

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

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BackgroundBlack and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.Aims and objectivesStudy 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.MethodsStudy 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’ResultsThere were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.ConclusionsStatutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Illness Encounters and Pathways To Carementioning

confidence: 99%

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

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“…Two studies reported using semi-structured questionnaires (Cole et al, 1995, Cougnard et al, 2004) and one reported simply asking patients for information on their contacts with professionals before admission and their pathways to care (Fuchs and Steinert, 2004). One study used the Encounter Form (Gater et al, 1991) and two others based their measures on other assessment tools (Etheridge et al, 2004, Norman et al, 2004; one on the IRIS audit tool kit (Partnerships, 2001) and the other, the Circumstances of Onset and Relapse Schedule (CORS) which is based on the Interview for the Retrospective Assessment of Schizophrenia (IRAOS) (Hafner et al, 1992). One study gathered data on pathways to care using qualitative techniques i.e.…”

Section: Pathways Measure Usedmentioning

confidence: 99%

Measuring pathways to care in first-episode psychosis: A systematic review

Singh

Grange

2006

Schizophrenia Research

119

120

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Background: Adequately measuring pathways to care is a prerequisite for early detection and effective treatment of first-episode psychosis. Method:We conducted a systematic review of studies on pathways to care in firstepisode psychosis to establish what measures currently exist to assess pathways in first-episode psychosis and to compare these measures. Results:We identified 15 studies which had used six different measures of pathways to care. Differences in aims, methodology and lack of psychometric data did not allow a direct comparison of pathways measures but certain common themes emerged.Discussion: Pathways to care in first-episode psychosis are diverse and varied. There is no measure with established psychometric properties that has been devised on a well-developed theoretical or conceptual framework and had its psychometric properties established. The conflict between exploring the patient"s narrative and journey through the healthcare system and developing an empirical measure of pathways with optimal outcomes has hindered the development of such a measure.

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“…In this study, somatic problems were found to be the most common initial presenting problem, and the majority of the patients had previously received some form of treatment for their present problem. 62 The proportion of patients with depressive disorders across centers was comparable. Contrary to what is often reported, somatic complaints were not more frequent in developing countries.…”

Section: No3 Mayo-junio De 1999mentioning

confidence: 93%

“…In addition, the study uncovered that recognizing depression by the physician does not mean that the patient will be provided with treatment, as only half were offered a drug treatment. 61,62 …”

Section: Pathways To Mental Health Carementioning

confidence: 99%