Optimizing health-care systems to promote early detection of psychosis

To discuss how health-care systems can achieve early detection of patients with first-episode psychosis.

A selective literature review was conducted.

The optimal design of health-care systems to promote early detection of psychosis had received considerable attention. Primary and specialist care both had important roles to play. Referral from primary care was a key pathway for patient identification. However, the recognition of emerging psychosis in the primary care setting can be challenging, and there was a need for educational initiatives to support primary care in performing this essential function. Rapid access to specialist care should be available when required. However, patients with early psychosis may not seek help from primary care for a variety of reasons, such as social withdrawal, lack of insight or fear of stigmatization. With this in mind, a number of assertive outreach programmes had been established that permit self-referral, rapid assessment and fast access to treatment. There was some evidence that these rapid detection units were successful in identifying 'harder-to-reach' patients. Finally, information campaigns aimed at the general public can raise awareness and promote help-seeking behaviours, and this appeared to be an important factor in reducing the duration of untreated psychosis.

To promote the rapid identification of patients with psychosis, health-care systems require a range of measures that recognize the different ways in which psychosis can be presented to the medical services. Education of general practitioners, assertive outreach, low-threshold detection teams and general information campaigns are all important elements of early detection.