Understanding the Pathways to Care for Individuals with or at Risk of Psychotic Disorders

Background: Delays in treatment for people experiencing early signs of psychosis are associated with poorer outcomes. However, it is not uncommon for individuals with an At-Risk Mental State (ARMS) and First Episode Psychosis (FEP) to experience lengthy delays to care and few people presenting with FEP access early intervention in psychosis (EIP) services during the prodromal stage. Pathways to Care (PtC) provides information about how individuals access services. This thesis aimed to explore PtC for individuals with ARMS and FEP, factors associated with accessing EIP at an earlier stage or psychosis, and interventions designed to reduce delays. Methods: A systematic review synthesised the available evidence on public health interventions designed to reduce delays to treatment for people with ARMS and FEP. An empirical study was conducted exploring PtC during ARMS compared to FEP, and sociodemographic characteristics associated with accessing EIP. Data were collected from a research database of de-identified clinical records. Results: Nineteen studies met the inclusion criteria for the systematic review. All studies consisted of FEP populations, with no papers investigating ARMS populations. Studies originated from various countries. Findings about the effectiveness of interventions at reducing duration of untreated psychosis (DUP) were mixed and interventions appeared to differentially impact groups. The most effective interventions appeared to be those of a longer duration and targeting multiple populations. PtC information was limited. In the empirical study, 158 individuals presenting with ARMS (n=67) and FEP (n=91) were included. There was strong evidence that ARMS patients accessing EIP were significantly younger and were less likely to be from ethnic minority backgrounds compared to FEP. ARMS patients had fewer PtC contacts, were less likely to be referred via acute services, less likely to have involuntary hospital admissions, and had reduced family involvement in their help-seeking. Conclusions: Findings regarding the effectiveness of interventions to reduce delays to treatment were inconclusive. The empirical paper highlighted sociodemographic and PtC characteristics associated with accessing EIP during ARMS compared with FEP. Further research is required to replicate these findings and investigate the effectiveness of targeted interventions to encourage and facilitate access to EIP at an earlier stage of psychosis to improve outcomes

The effectiveness of public health interventions, initiatives, and campaigns designed to improve pathways to care for individuals with psychotic disorders: A systematic review

Purpose: Lengthy duration of untreated psychosis (DUP) and duration of untreated illness (DUI) in people at clinical high-risk for psychosis (CHR-P) and first episode psychosis (FEP) is associated with poorer outcomes. However, individuals with FEP often experience negative pathways to care involving contacts with police, crisis services and requiring compulsory admissions, and evidence suggests individuals with both FEP and CHR-P often experience lengthy delays to treatment. Early detection interventions, such as public health interventions, may be one way to reduce delays. This systematic review aimed to synthesise the available evidence on such interventions. Methods: The EMBASE, PsychINFO, CINAHL, and MEDLINE databases were searched. Studies were included if they compared an intervention designed to improve timely access to treatment for individuals with FEP or CHR-P to standard treatment provision. Interventions may be targeted at potential patients, their families, the general public, or non-healthcare professionals. Outcomes of interest were DUP or DUI, and/or characteristics of pathways to care. Results: Nineteen studies met the inclusion criteria. All consisted of FEP populations, none of CHR-P populations. Employing narrative synthesis, we found mixed results about the effectiveness of interventions at reducing DUP and interventions appeared to differentially impact groups. Pathways to care information was limited and mixed. Conclusion: Findings on the effectiveness of interventions designed to improve timely access to treatment were inconclusive. More research is warranted to better understand where delays occur and factors which may influence this for both FEP and CHR-P populations which may help to develop targeted interventions to address delays

CivicLAB Symposium proceedings

Civic LAB is a collaborative research Civic Lab is an interdisciplinary research group centred on participatory culture, creative dialogue and experiential design for social impact. How do we build communities (Manzini, 2019) and how can we create the conditions in which those communities can sustainably develop, innovate and thrive within the social, economic, environmental and cultural challenges of the 21st century? Researchers and practitioners in the Lab amalgamate a diverse span of creative practices and perspectives across the arts and social sciences to contribute to this burgeoning field of enquiry; interrogating, extending and redefining the value of creative practice to the public sphere. As a research forum for partnership and transfer of knowledge and best practices, the lab offers thoughtful and provocative readings of this sphere, through practical and theoretical acts of research and dissemination. The LAB promotes and supports a wide range of multidisciplinary creative research activities working with external cultural partners, public, commercial and third sector organisations, educational institutions and international networks. Through public engagement, participation and collaboration we aim to develop, deploy, evaluate and publish projects, works and methodologies which engender sustainable social, environmental and cultural impact. This research group is aligned to The Digital and Material Artistic Research Centre (DMARC) at the University of Derby, which addresses the shifting boundaries within the terrain of creative and artistic research. The work of the lab articulates a public pedagogy which effaces the boundaries between research, teaching, and the University’s civic agenda to create a positive impact in a range of contexts including, but not limited to: • socially engaged artistic research practice • health and wellbeing • social justice, mobility and inequality • participatory placemaking/place-reshaping • play, pedagogy and educational development • cultural heritage and belonging This is the first Civic LAB Symposium Civic LAB is a research group that sits within DMARC – the Digital Material Artists Research Centre based in the College of Arts, Humanities and Education. As a LAB we very much support and encourage a cross university way of working both internally and externally with stakeholder and the public. We want to use this symposium as a platform for profiling the brilliant research that is being undertaken by colleagues here at Derby but also those from other H.E institutions, such as University of Nottingham, Swansea University, University of Helskini, University of Manchester, University for the Creative Arts. We also have colleagues joining us from Derby County Community Trust, Derby Cathedral and Derby Theatre. We are joined by The Council for Higher Education in Art & Design (CHEAD), East Street Arts, Cumulus the only Global association to serve art and design education and research, The Mighty Creatives and European Cultural Academy, Venice. This fantastic group of organisations and individuals will enrich our thinking and sharing of methods of best practice and research and regroup our thinking in what we mean by Civic Life, and its impact on and relationship to each of us as academics, as citizens and industry professionals.Derby Cathedral Derby County Community Trust Derby Theatre Derby City Council Manchester University Mighty Creatives University of Swansea Tate Research Cumulus FACE CHEAD European Cultural Academy University of Nottingha

Civic LAB Symposium 2021

The online Symposium: CivicLAB presents the work of researchers, artists and creative industry colleagues from across the UK, including international colleagues from Venice, Finland, USA. Speakers were from European Cultural Academy , Tate Exchange, Derby County Community Trust, Derby Theatre, Derby Cathedral, University of Manchester, East Street Arts, Space and Place Lead, Council for Higher Education Art and Design (CHEAD), Fashion Academics Creating Equality (FACE), University for the Creative Arts, Cumulus Association, University of Swansea, Mighty Creatives, University of Nottingham, University of Derby, Each speaker focuses on participatory culture, creative dialogue and experiential design for social impact. Questions asked include: How do we build communities (Manzini, 2019) and how can we create the conditions in which those communities can sustainably develop, innovate and thrive within the social, economic, environmental and cultural challenges of the 21st century? Researchers and practitioners in the LAB amalgamate a diverse span of creative practices and perspectives across the arts and social sciences to contribute to this burgeoning field of enquiry; interrogating, extending and redefining the value of creative practice to the public sphereThe Symposium events were organised and curated by Dr Rhiannon Jones supported by co-conveners Dr Daithi McMahon, Jade Murden and supported by Matt Hawthorn, The Symposium includes papers, presentations, panels, Keynote and workshops by the following international speakers: Dr Cara Courage, Dr Daithí McMahon, Dr Nick Owen (MBE), Dr Annie Tubadjiat, Dr Larissa Allwork Dr Rhiannon Jones, Dr Clive Holmwood, Dr Teresa Forde, Dr Maria Photiou, Dr Gemma Collard-Stokes, Panel Speakers: Liz Ange, Alexandra Laqueuer, Anna Lindberg, Benita Odogwu-Atkinson, Sandra Booth, Caroline Barth, The Very Rev'd Dr Peter Robinson, Dr Victoria Barker, Professor Cecile Wright, Simon Carnell.N/