Ethnic variation in access to treatment for First-Episode Psychosis in the East Midlands : A mixed methods study
thesisposted on 06.11.2014, 11:46 by Alexander Satchwell
Literature Review: Purpose: To determine differences in Duration of Untreated Psychosis (DUP) and Pathways to Care (PtC) between ethnic groups for service users with first-episode psychosis. Method: Literature searches were conducted using the online databases PsychInfo, Medline, Science Direct, Web of Science, Scopus and ASSIA. Keywords selected for searches included the terms Duration of Untreated Psychosis, Pathways to Care and Ethnic* or Cultur* or Diversity. Results: Ten relevant articles were identified. Five were cohort studies and five were cross-sectional studies. Conclusions: Mixed evidence was found regarding the influence of ethnicity on DUP. Findings on PtC were clearer, with minority ethnic groups often reported as more likely to access care via negative pathways, such as criminal justice agencies. Research Report: Objectives: 1) To explore the effects of ethnicity and other variables on DUP and PtC in an EIP service in Leicestershire and Rutland. 2) To develop an understanding of the barriers GPs experience when presented with a service user with first-episode psychosis. Method: A mixed methods design was adopted. Firstly, a naturalistic cohort study involving 426 individuals from an EIP service was analysed. Semi-structured interviews were also conducted with six GPs and one focus group. Interview data was analysed using Thematic Analysis. Results: No associations were found between ethnicity and any DUP variables. Ethnic differences were reported for three PtC: Criminal Justice Agencies; Accident and Emergency services; and Inpatient services. Thematic Analysis of GP interviews indicated three key themes. These were ‘a grey area’, ‘dilemmas’, and ‘more in depth mental health training’. Conclusions: Ethnic differences were only observed with specific PtC, which supported evidence by Ghali et al. (2012). GP and public education programmes were perceived as necessary in reducing delay, and minimising the impact stigma and shame have on service users’ and families’ help-seeking behaviour. Critical Appraisal: A reflective account of the research process and learning outcomes are described and discussed.