Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T07:41:09.545Z Has data issue: false hasContentIssue false
  • English
  • Français

Outreach and Support in South London (OASIS). Outcomes of non-attenders to a service for people at high risk of psychosis: the case for a more assertive approach to assessment

Published online by Cambridge University Press:  21 April 2010

C. E. L. Green ,
P. K. McGuire ,
M. Ashworth  and
L. R. Valmaggia
C. E. L. Green*
Affiliation:
King's College London, King's Health Partners, Institute of Psychiatry, Department of Psychosis Studies, and Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
P. K. McGuire
Affiliation:
King's College London, King's Health Partners, Institute of Psychiatry, Department of Psychosis Studies, and Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
M. Ashworth
Affiliation:
King's College London, King's Health Partners, Department of Primary Care & Public Health Sciences, London, UK
L. R. Valmaggia
Affiliation:
King's College London, King's Health Partners, Institute of Psychiatry, Department of Psychosis Studies, and Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, London, UK
*
*Address for correspondence: Dr C. E. L. Green, OASIS, PO 67, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

International agreement dictates that clients must be help-seeking before any assessment or intervention can be implemented by an ‘at-risk service’. Little is known about individuals who decline input. This study aimed to define the size of the unengaged population of an ‘at-risk service’, to compare this group to those who did engage in terms of sociodemographic and clinical features and to assess the clinical outcomes of those who did not engage with the service.

Method

Groups were compared using data collected routinely as part of the service's clinical protocol. Data on service use and psychopathology since referral to Outreach and Support in South London (OASIS) were collected indirectly from clients' general practitioners (GPs) and by screening electronic patient notes held by the local Mental Health Trust.

Results

Over one-fifth (n=91, 21.2%) of those referred did not attend or engage with the service. Approximately half of this group subsequently received a diagnosis of mental illness. A diagnosis of psychosis was given to 22.6%. Nearly 70% presented to other mental health services. There were no demographic differences, except that those who engaged with the service were more likely to be employed.

Conclusions

Over one-fifth of those referred to services for people at high risk of psychosis do not attend or engage. However, many of this group require mental health care, and a substantial proportion has, or will later develop, psychosis. A more assertive approach to assessing individuals who are at high risk of psychosis but fail to engage may be indicated.

Keywords

At-risk mental stateearly interventionpsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 2 , February 2011 , pp. 243 - 250
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Broome, MR, Wooley, JB, Johns, LC, Valmaggia, LR, Tabraham, P, Gafoor, R, Bramon, E, McGuire, P (2005). Outreach and Support in South London (OASIS): implementation of a clinical service for prodromal psychosis and the at risk mental state. European Psychiatry 20, 372–378.CrossRefGoogle ScholarPubMed
Cannon, TD, Cadenhead, K, Cornblatt, C, Woods, SW, Addington, J, Walker, E, Seidman, LJ, Perkins, DO, Tsuang, M, McGlashan, TH, Heinssen, R (2008). Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Archives of General Psychiatry 65, 28–37.CrossRefGoogle ScholarPubMed
Drake, R, Haley, C, Akhtar, S, Lewis, S (2000). Causes and consequences of duration of untreated psychosis in schizophrenia. British Journal of Psychiatry 177, 511–515.Google Scholar
International Early Psychosis Association Writing Group (2005). International clinical practice guidelines for early psychosis. British Journal of Psychiatry (Suppl.) 18, S120–S124.Google Scholar
McGlashan, TH, Zipursky, RB, Perkins, D, Addington, J, Miller, T, Woods, SW, Hawkins, KA, Hoffman, RE, Preda, A, Epstein, I, Addington, D, Lindborg, S, Trzaskoma, Q, Tohen, M, Breier, A (2006). Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. American Journal of Psychiatry 163, 790–799.CrossRefGoogle ScholarPubMed
McGorry, PD, Yung, AR, Phillips, LJ, Yuen, HP, Francey, S, Cosgrave, EM, Germano, D, Bravin, J, McDonald, T, Blair, A, Adlard, S, Jackson, H (2002). Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Archives of General Psychiatry 59, 921–928.CrossRefGoogle Scholar
Morrison, A, Bentall, R, French, P, Walford, L, Kilcommons, A, Knight, A, Kreuz, M, Lewis, SW (2002). Randomised controlled trial of early detection and cognitive therapy for preventing transition to psychosis in high-risk individuals. Study design and interim analysis of transition rate and psychological risk factors. British Journal of Psychiatry 43, S78–S84.Google Scholar
Morrison, AP, French, P, Walford, L, Lewis, S, Kilcommons, A, Green, J, Parker, S, Bentall, RP (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. British Journal of Psychiatry 185, 291–297.CrossRefGoogle ScholarPubMed
Phillips, LJ, Nelson, B, Yuen, HP, Francey, SM, Simmons, M, Stanford, C, Ross, M, Kelly, D, Baker, K, Conus, P, Amminger, P, Trumpler, F, Yun, Y, Lim, M, McNab, C, Yung, AR, McGorry, PD (2009). Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: study design and baseline characteristics. Australian and New Zealand Journal of Psychiatry 43, 818–829.CrossRefGoogle ScholarPubMed
Valmaggia, LR, McCrone, P, Knapp, M, Woolley, JB, Broome, MR, Tabraham, P, Johns, LC, Prescott, C, Bramon, E, Lappin, J, Power, P, McGuire, PK (2009). Economic impact of early intervention in people at high risk of psychosis. Psychological Medicine 39, 1617–1626.CrossRefGoogle ScholarPubMed
Warner, R (2005). Problems with early and very early intervention in psychosis. British Journal of Psychiatry 187, S104–S107.CrossRefGoogle Scholar
Woods, SW, Breier, A, Zipursky, RB, Perkins, DO, Addington, J, Miller, TJ, Hawkins, KA, Marquez, E, Lindborg, SR, Tohen, M, McGlashan, TH (2003). Randomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome. Biological Psychiatry 54, 453–464.Google Scholar
Yung, AR, Phillips, LJ, McGorry, PD, McFarlane, CA, Francey, S, Harrigan, S, Patton, GC, Jackson, HJ (1998). Prediction of psychosis. A step towards indicated prevention of schizophrenia. British Journal of Psychiatry (Suppl.) 172, 14–20.Google Scholar
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, Francey, SM, Cosgrave, E, Killackey, E, Stanford, C, Godfrey, K, Buckby, J (2005). Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Australian and New Zealand Journal of Psychiatry 39, 964–971.Google Scholar