The role of key workers in improving physical health in first episode psychosis: A scoping review

Abstract

Aim Studies have demonstrated that a majority of the decline in health status and functioning emerges during the first few years following the onset of psychosis. This knowledge led to the development of specialized early intervention services (EIS) targeting patients experiencing their first episode of psychosis (FEP). The central component of EIS is often assertive case management delivered by a multidisciplinary team, where an appointed key worker is responsible for coordinating treatment and delivering various psychosocial interventions to service users. The aim of this scoping review was to examine how key workers can enhance the physical health outcomes in people with FEP by addressing the factors associated with increased mortality in this population. Methods The scoping review framework comprised a five‐stage process developed by Arksey and O'Malley. The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. Results A total of 27 studies conducted across 10 countries were analysed. These studies discussed the various ways in which key workers can mediate enhancements in the various factors contributing to the increased mortality rates in FEP patients. Conclusions A broad range of key worker‐mediated outcomes was identified, which were broadly classified into three themes: influences on lifestyle, influences on effects of psychosis and influences on organizational barriers. Our findings suggest that key workers primarily mediated the amelioration of psychosis‐induced effects and the reduction of organizational barriers. Further trials of key worker interventions to enhance physical health outcomes in this cohort are warranted.

Keyworker mediated enhancement of physical health in patients with first episode psychosis: A feasibility/acceptability study

“…Our high‐retention rate meanwhile was like those reported in several similar studies (Firth et al, 2018; Korman et al, 2020; Teasdale et al, 2016; Usher et al, 2019; Williams et al, 2016). Meanwhile, our finding that participants valued keyworker support, particularly regarding physical health issues, reaffirms those of a recently published review of keyworker interventions for FEP patients (Lim et al, 2020). Also, we believe our findings are unique because they; (i) shed new light on the nature and potential of relationships between physical health keyworkers, FEP patients and third parties (particularly GPs) and (ii) demonstrate the acceptability of a telemedicine intervention for patients with severe mental health issues during the COVID‐19 pandemic.…”

“…The intervention was conducted from February through April 2020. As noted, it was informed by the MRC's Framework (Campbell et al, 2000), as well as our study protocol (McCombe et al, 2019), a scoping review conducted on keyworker involvement in FEP patient care (Lim et al, 2020), 10 semi‐structured interviews with healthcare professionals (general practitioners [GPs] and psychiatrists), steering group meetings, and Ireland's national model of care for FEP (Health Service Executive (HSE), 2019) and making every contact count initiatives (O'Brien & Scott, 2016). The intervention sought to provide keyworker led interventions that; (a) enhance FEP participants' physical health and (b) improve integration between healthcare providers (especially MHSs and GPs) regarding participants' physical health issues requiring follow‐up.…”

“…In Ireland's FEP model of care, keyworkers are valuable members of multidisciplinary teams as they serve as the main point of contact between services and service users, and manage personalized patient care plans (Power, 2019). The value of keyworkers was further highlighted in a recent scoping review (Lim et al, 2020), where they were shown to assume various important responsibilities including coordinating health services, psychoeducation and assisting patients with practical and emotional needs. These responsibilities put keyworkers in a unique position to help ameliorate the organizational barriers (e.g., fragmented care systems) and poor lifestyle choices contributing to the poorer physical health of FEP patients (Lim et al, 2020).…”

“…Previous studies have evaluated both keyworker (Lim et al, 2020) and physical health interventions for FEP patients (Firth et al, 2018; Gallagher et al, 2020; Korman et al, 2020; Teasdale et al, 2016; Usher et al, 2019; Williams et al, 2016), with both kinds of interventions showing promise. However, to our knowledge, no studies have evaluated keyworker‐mediated interventions seeking to promote FEP patients' physical health.…”

Perspectives of mental health clinicians on physical health of young people with early psychosis

“…In Lim et al. 's (2020) scoping review, referral to an Exercise Physiologists was suggested to promote better PH outcomes. However, our results identified that a reactive approach to provide more assertive care for concerning signs of PH deterioration was seen more widely in practice.…”