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The Lambeth Early Onset Crisis Assessment Team Study: general practitioner education and access to an early detection team in first-episode psychosis

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

EDUARDO IACOPONI, MRCPsych, PhD

LEO Services South London and Maudsley NHS Trust, London, UK

NICOLA REYNOLDS, BSc, HELEN FISHER, MSc, MORRIS RUSSELL, BSc and PHILIPPA A. GARETY, PhD, FBPsS

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

PHILLIP K. McGUIRE, FRCPsych, MD, PhD

OASIS and Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

TOM CRAIG, MRCPsych, PhD

Division of Psychological Medicine, Institute of Psychiatry, King’s College London, UK

Correspondence: Dr Paddy Power, LEO Services, South London and Maudsley NHS Trust, 108 Landor Road, London SW9 9NT, UK. Tel: +44 (0) 203 228 6222; Fax: +44 (0) 203 228 6253; email: Paddy.Power{at}slam.nhs.uk

Background There are few evaluations of strategies to improve rates of early detection and treatment of patients with first-episode psychosis.

Aims To evaluate the effectiveness of a general practitioner (GP) education programme and an early detection assessment team (the Lambeth Early Onset Crisis Assessment Team;LEO CAT) in reducing delays in accessing treatment for first-episode psychosis patients.

Method 46 clusters of GP practices randomised to GP education in early detection with direct access to LEO CATv. care as usual. Primary outcome measures were GP referral rates, duration of untreated psychosis (DUP) and delays in receiving treatment.

Results 150 patients with first-episode psychosis were recruited; 113 were registered with the study GPs, who referred 54 (47.7%) directly to mental health services. Significantly more intervention group GPs (86.1% v. 65.7%) referred their patients directly to mental health services and fewer patients experienced long delays in receiving treatment. However, their overall DUP was unaffected.

Conclusions Educating GPs improves detection and referral rates of first-episode psychosis patients. An early detection team reduces the long delays in initial assessment and treatment. However, these only impact on the later phases of the DUP. Broader measures, such as public health education, are needed to reduce the earlier delays in DUP.