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Open Access Study protocol

Don’t turn your back on the symptoms of psychosis: a proof-of-principle, quasi-experimental public health trial to reduce the duration of untreated psychosis in Birmingham, UK

Charlotte Connor12*, Max Birchwood34, Colin Palmer1, Sunita Channa1, Nick Freemantle5, Helen Lester6, Paul Patterson27 and Swaran Singh8

Author Affiliations

1 CLAHRC, Birmingham & Solihull Mental Health Foundation Trust, 66-68 Hagley Road, B16 8PF, Birmingham, UK

2 School of Psychology, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK

3 Youth Mental Health, School of Psychology, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK

4 Youthspace Mental Health Service, Birmingham and Solihull Mental Health Foundation Trust, Edgbaston, B15 2TT, Birmingham, UK

5 Clinical Epidemiology & Biostatistics, Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, NW3 2PF, London, UK

6 Primary Care, Primary Care Clinical Sciences, School of Health and Population Sciences, Primary Care Clinical Sciences Building, University of Birmingham, Edgbaston, B15 2TT, Birmingham, UK

7 Youthspace, Birmingham & Solihull Mental Health Foundation Trust, 66-68 Hagley Road, B16 8PF, Birmingham, UK

8 Mental Health & Wellbeing, Medical School Building, Gibbet Hill Campus, University of Warwick, CV4 7AL, Coventry, UK

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BMC Psychiatry 2013, 13:67  doi:10.1186/1471-244X-13-67

Published: 22 February 2013

Abstract

Background

Reducing the duration of untreated psychosis (DUP) is an aspiration of international guidelines for first episode psychosis; however, public health initiatives have met with mixed results. Systematic reviews suggest that greater focus on the sources of delay within care pathways, (which will vary between healthcare settings) is needed to achieve sustainable reductions in DUP (BJP 198: 256-263; 2011).

Methods/Design

A quasi-experimental trial, comparing a targeted intervention area with a ‘detection as usual’ area in the same city. A proof-of–principle trial, no a priori assumptions are made regarding effect size; key outcome will be an estimate of the potential effect size for a definitive trial. DUP and number of new cases will be collected over an 18-month period in target and control areas and compared; historical data on DUP collected in both areas over the previous three years, will serve as a benchmark. The intervention will focus on reducing two significant DUP component delays within the overall care pathway: delays within the mental health service and help-seeking delay.

Discussion

This pragmatic trial will be the first to target known delays within the care pathway for those with a first episode of psychosis. If successful, this will provide a generalizable methodology that can be implemented in a variety of healthcare contexts with differing sources of delay.

Trial registration

http://www.controlled-trials.com/ISRCTN45058713 webcite

Keywords:
Public mental health campaign; First-episode psychosis; Early detection; Duration of untreated psychosis; Youth mental health