Service users' views of moving on from early intervention services for psychosis: a longitudinal qualitative study in primary care.
Lester H., Khan N., Jones P., Marshall M., Fowler D., Amos T., Birchwood M.
BACKGROUND: The role of primary care for young people with psychosis, and transitions between specialist mental health services and primary care, are underexplored areas, both clinically and in research terms. AIM: To explore service users' perspectives of early intervention services and primary care, in-depth and over time. DESIGN AND SETTING: Longitudinal qualitative methodology in five geographically diverse sites across England. METHOD: Semi-structured interviews with 21 young people with first-episode psychosis at two time points. RESULTS: Early intervention services are highly prized by service users; however, the 'gold standard' nature of the care is difficult to replicate in other services and may lead to unrealistic expectations. Flexibility in terms of the timing of discharge does appear to be happening in practice, but continuity is not always well established before discharge. Primary care seems to be under-utilised, both as a location of care during time with the early intervention service and as a skill set, particularly for physical health problems. Service users expected GPs to advocate for and navigate the health system, particularly at times of crisis or relapse. CONCLUSION: Early intervention services should focus on actively establishing relationships between service users and either the community mental health team or the GP in the months leading up to discharge, and ensuring that service users' expectations about access and availability of care are 'realistic'. Primary care could be better utilised, even when service users are actively engaged with early intervention services, to help ensure physical health needs are met from the start of treatment.