What happens after early intervention? Mapping early intervention in
psychosis care pathways in the twelve months after discharge
Abstract
Aim: Early intervention services are the established and evidence-based
treatment option for individuals with first-episode psychosis. They are
time-limited, and care pathways following discharge from these services
have had little investigation. We aimed to map care pathways at the end
of early intervention treatment to determine common trajectories of
care. Methods: We collected health record data for all individuals
treated by early intervention teams in two NHS mental health trusts in
England. We collected data on individuals’ primary mental health care
provider for 52 weeks after the end of their treatment and calculated
common trajectories of care using sequence analysis. Results: We
identified 2224 eligible individuals. For those discharged to primary
care we identified four common trajectories: Stable Primary Care,
Relapse and return to CMHT, Relapse and return to EIP, and Discontinuity
of Care. We also identified four trajectories for those transferred to
alternative secondary mental health care: Stable Secondary Care,
Relapsing Secondary Care, Long-term Inpatient, and Discharged Early. The
Long-term Inpatient trajectory (1% of sample) accounted for 29% of all
inpatient days in the year follow-up, with Relapsing Secondary Care (2%
of sample and 21% of inpatient days), and Relapse and return to CMHT
(5% of sample, 15% of inpatient days) the second and third most
frequent. Conclusions: Individuals have common care pathways at the end
of early intervention in psychosis treatment. Understanding common
individual and service features that lead to poor care pathways could
improve care and reduce hospital use.