A comparison of pathways to care in at-risk mental states and first episode psychosis: A mental health electronic clinical records analysis in the East of England, UK

Purpose: Delays in treatment for individuals experiencing early signs of psychosis are associated with poorer outcomes. Few people presenting with first episode psychosis (FEP) access early intervention in psychosis (EIP) services during the prodromal stage. In this study, we compared pathways to care (PtC) in people with At-Risk Mental States (ARMS) and FEP and explored the sociodemographic factors associated with accessing EIP during ARMS or FEP.

Methods: Sociodemographic and PtC data were collected from the Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) Research Database. All individuals referred and accepted to CPFT EIP services as either ARMS or FEP between 1st April 2018 and 31st October 2019 (N = 158) were included.

Results: There was strong evidence that ARMS patients accessing EIP were younger and were less likely to have a minority ethnic status than FEP patients. In terms of PtC, ARMS patients had fewer numbers of contacts, were less likely to be referred via the acute services, less likely to be involuntarily admitted and had reduced family involvement in their help-seeking. No differences were identified between ARMS and FEP in terms of living circumstances, area-level deprivation, urbanicity, employment status, duration of PtC, or police involvement in PtC.

Conclusion: Our findings highlight that disparities exist between ARMS and FEP patients in terms of sociodemographic and PtC characteristics. Further research is required to replicate these findings and investigate the effectiveness of interventions to encourage and facilitate access to EIP at an earlier stage to improve outcomes.