Pathway to care for patients with first-episode psychosis in Hong Kong

Abstract Objective: To describe the pathway to care for patients with first-episode psychosis in Hong Kong. Patients and Methods: Thirty five consecutive patients attending the Early Assessment Service for Young People with First-episode Psychosis at Queen Mary Hospital were recruited. All patients were systematically interviewed about the issues relating to the help-seeking pathway before receiving treatment. Results: A longer duration of untreated psychosis was associated with more clinical symptomatology than a shorter duration of untreated psychosis. A significant proportion of patients accessed the early assessment service directly. The most frequently reported first contact was a primary care physician or a social worker. Conclusion: This exploratory study underlines the importance of engaging patients with first-episode psychosis and their relatives with primary care physicians and/or social workers for early intervention. Key words: Hong Kong, Psychotic disorders Introduction Empirical studies have shown that the duration of untreated psychosis (DUP) of individuals with psychosis averages 1 to 2 years. (1-4) It has also been demonstrated that a longer DUP is associated with poorer outcome in terms of symptoms, functioning, and relapse. (5-7) There are various potential obstacles to receiving prompt treatment, including patients' lack of insight, relatives' lack of information, fear of stigmatisation, withdrawal and poor social network, and accessibility of services. (6-8) However, the majority of studies are based on western patients and few data are available for non-western groups. Drake et al suggested that the help-seeking pathway is the critical link between the onset of a psychiatric disorder and service provision. (6) The formulation of a help-seeking pathway model will enhance the understanding of psychiatric services, and suggest possible measures of improvement. (9) For example, the Calgary pathway to care study examined the number of attempts patients with first-episode psychosis (FEP) made to obtain treatment before their arrival at the Early Psychosis Program. (10) The mean number of contacts per person was 2.3, and patients sought help from emergency services (32.5%), primary care physicians (22.7%), psychologists (10.8%), psychiatrists (10.3%), and friends (5.2%). From this study, the investigators concluded that by improving the public and primary care professionals' recognition of early psychotic symptoms, the DUP could be shortened. In Hong Kong, with a population of approximately 7 million, the Early Assessment Service for Young People with First-episode Psychosis (EASY) programme was established in 2001. The EASY programme accepts referrals of patients with FEP aged between 15 and 25 years. The service aims to improve the outcome for patients with early psychosis by the following approaches: media and public education about psychosis to enhance early detection (e.g., using posters, pamphlets, exhibition boards, and videos); early referral and assessment, open referral from medical professionals, or self-referral via a telephone help-line and the Internet; and comprehensive pharmacological and psychosocial management for identified patients and their carers. To date, no study performed in Hong Kong has examined the pathway to care for patients with FEP. This study reviewed the help-seeking pathways for patients with FEP and systematically explored the reasons for delay in seeking treatment for a consecutive group of patients attending the EASY programme. Patients and Methods Patients were recruited from the EASY programme at Queen Mary Hospital (QMH), which covers the catchment area of Hong Kong Island and East Kowloon. The catchment area population is approximately 1.9 million or 28% of the population of Hong Kong. (11) The study was approved by the ethics committee at QMH. Patients Consecutive patients assessed to be suitable for the EASY programme were recruited into the study. …