Pathways to care

What are pathways to care? 

The help-seeking efforts made by an individual and their families when symptoms of psychosis are apparent, and the clinical services made available as a result of these efforts, are collectively known as ‘pathways to care’. Pathways to care can also encompass service structures that have not been actively sought by the individual. Understanding pathways to care may improve early intervention strategies and contribute to reducing the duration of untreated psychosis.

What is the evidence for pathways to care?

Moderate to low quality evidence suggest young people have around three contracts before receiving specific services for first-episode psychosis. General practitioners are the most common first contact, followed by psychiatrists or specialised services, emergency or inpatient units, family or friends then social workers. Contacts with counsellors or courts led to longer duration of untreated psychosis, which was shortest following referrals from emergency services or general practitioners. Contact with the criminal justice system, emergency or inpatient units were associated with poor patient experiences, disengagement and high costs, despite sometimes resulting in reduced treatment delays.

Moderate quality evidence suggests having a sense of being different or not normal and characterising this difference negatively leads to fewer pathways to care for people with first-episode psychosis or at-risk mental states. Anticipating and experiencing negative reactions from self or others, employing strategies to avoid these negative reactions (such as nondisclosure of symptoms), lack of awareness and understanding of mental illness, and having a negative opinion of services also impacts on pathways to care. Perceived stigma is associated with more negative help-seeking attitudes towards treatment, and service-related stigma is a reason for opposing psychiatric treatment. Shame is the main reason for nondisclosure of symptoms. Care-givers’ concern that loved ones experiencing first-episode psychosis would be labelled as ‘mad’ was a frequent reason for relatives not contacting psychiatric services.

Black people in the U.K. may be more likely to have had compulsory hospital admissions than white people in the U.K, particularly those of African Caribbean or Black African ethnicity. Black people in the UK are also less likely to be hospitalised on first presentation, or to be referred to specialist services, and police are more likely to have been involved during admission. There may be fewer compulsory admissions for Asians with first-episode psychosis in Canada than for Whites, Blacks or those of other ethnic backgrounds.

March 2019

Last updated at: 5:24 am, 26th March 2019
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