Plain English Summary
Background and study aims
First-episode psychosis refers to the first time someone experiences psychotic symptoms or a psychotic episode. Young people are particularly vulnerable to developing psychosis; symptoms can be very disturbing and confusing and can include hallucinations, delusions and feelings of paranoia. Distress may be further increased by negative myths and stereotypes that are present in our society about mental illness. International studies have shown that some young people with psychosis can experience long delays in getting treatment (duration of untreated psychosis or DUP). Such delays can have important consequences for their treatment response and long-term outcome. The main sources of long delays are often due to poor help-seeking behaviour and delays within mental health services themselves, suggesting the need for greater focus on the sources of these delays in tackling them. The aim of this study is to reduce these long delays (or DUP) and improve the care pathways of young people experiencing first-episode psychosis by carrying out a psychosis awareness public health campaign which will run alongside a new youth access mental health service. These interventions will provide information and guidance on when, where and how to seek help for psychosis, and provide a single referral point for young people with first-episode psychosis, to ensure they receive care from a youth sensitive team and guarantee direct access to a specialised service.
Who can participate?
The psychosis awareness campaign is aimed at young people (aged 14 30) in the south of Birmingham who may be experiencing symptoms of psychosis, their carers and those who work with young people, to raise awareness and provide information about when, where and how to seek help. Alongside provision of a bespoke youth mental health website (www.youthspace.me/psychosis) and a psychosis information line, the campaign will use media, advertising and community events to engage with the south Birmingham community, situating itself in local shopping centres, supermarkets and employment centres. It will also collaborate with youth, community and education groups.
What does the study involve?
The youth access team will operate alongside existing CMHTs in the south of Birmingham to provide direct referral channels and immediate assessments for all young people presenting to primary care with mental health difficulties. DUP and numbers of young people with first-episode psychosis entering the youth access team from the intervention area will be compared with the DUP and numbers of young people with first-episode psychosis entering services from the rest of Birmingham.
What are the possible benefits and risks of participating?
There are no risks from participation as DUP is routinely collected at entry into specialist services as part of initial assessments of all young people with first-episode psychosis.
Where is the study run from?
The awareness campaign and the youth access team are both based in south Birmingham and will operate as a pilot study which will inform a definitive trial.
When is the study starting and how long is it expected to run for?
The study began in January 2012 and will run for 18 months.
Who is funding the study?
The study is funded by the National Institute of Mental Health (UK).
Who is the main contact?
Dr Charlotte Connor
c.s.connor@bham.ac.uk
Trial website
Contact information
Type
Scientific
Primary contact
Prof Max Birchwood
ORCID ID
Contact details
University of Birmingham
School of Psychology
Frankland Building
Edgbaston
Birmingham
B15 2TT
United Kingdom
m.j.birchwood.20@bham.ac.uk
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
N/A
Study information
Scientific title
Dont 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.
Acronym
Study hypothesis
Will implementation of a psychosis awareness public health campaign, in addition to a youth access pathway for first episode psychosis, significantly reduce duration of untreated psychosis (DUP).
Ethics approval
Not provided at time of registration
Study design
This is a quasi-experimental, proof-of-principle prospective trial comparing an intervention area in the south of the city, to the non-intervention remainder of the city.
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Other
Trial type
Prevention
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Condition
First-episode psychosis
Intervention
1. Psychosis Awareness Campaign
To improve the help-seeking of young people and their carers, who are experiencing symptoms of first-episode psychosis providing information about when, where and how to seek help. Individuals are encouraged to access a helpline and a bespoke website.
The campaign will comprise of the following elements:
1.1. Advertising in high use settings.
1.2. Leaflet drops
1.3. Advertising in community press
1.4. Advertising on community websites
1.5. Attendance at community events
1.6. Promotion of www.youthspace.me/psychosis
1.7. The Psychosis Information line
1.8. Youth Advisors
1.9. Psychosis Awareness Training
2. Youth mental health care pathway - to improve the care pathway.
Intervention type
Other
Phase
Not Specified
Drug names
Primary outcome measure
DUP is routinely assessed for all young people entering services as part of their clinical assessment. Incident cases of first episode psychosis will be determined and their DUP and care pathways ascertained over the 18 months period.
Secondary outcome measures
1. Increase in referrals of young people diagnosed with a psychotic disorder from the intervention area into EIS.
2. We also benefit from historical DUP data (National EDEN) 19 (August 2005 June 2009) for both target and control areas
Overall trial start date
07/01/2012
Overall trial end date
07/09/2013
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
All new cases of first episode psychosis accepted by the Early Intervention in psychosis Service.
Participant type
Patient
Age group
Adult
Gender
Both
Target number of participants
A proof-ofprinciple trial, key outcome will be an estimate for a definitive trial. The population of our intervention are the size of the community we are trying to target (308,150)
Participant exclusion criteria
Patients considered at ultra-high risk of psychosis are excluded. Since this is a pragmatic trial focussing on reducing DUP in patients managed within an EIS, there will be no other exclusions
Recruitment start date
07/01/2012
Recruitment end date
07/09/2013
Locations
Countries of recruitment
United Kingdom
Trial participating centre
University of Birmingham
Birmingham
B15 2TT
United Kingdom
Sponsor information
Organisation
National Institute of Health Research [NIHR] (UK)
Sponsor details
Room 132
Richmond House
79 Whitehall
London
SW1A 2NS
United Kingdom
enquiries@nihr.ac.uk
Sponsor type
Government
Website
Funders
Funder type
Government
Funder name
NIHR CLAHRC Programme for Birmingham and the Black Country (UK)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
Publication list
2013 protocol in http://www.ncbi.nlm.nih.gov/pubmed/23432935
Publication citations
-
Protocol
Connor C, Birchwood M, Palmer C, Channa S, Freemantle N, Lester H, Patterson P, Singh S, 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., BMC Psychiatry, 2013, 13, 67, doi: 10.1186/1471-244X-13-67.