Duration of Untreated Psychosis (DUP): A Public Health Study by Max Birchwood

A trial led by Warwick's Max Birchwood to reduce the delay in young people recieving help for first-time psychosis. If successful, the trial could provide a methodology to reduce various types of delay across the healthcare system.

DUP Research

Studies suggest that a long Duration of Untreated Psychosis in childhood can affect remission, positive symptoms and social functioning up to 8 years later¹ and is linked to risk of harm to self or others^2-4, making the reduction of DUP an international target⁵.

In Birmingham, initial pathfinder studies revealed a third of young people from Birmingham Early Intervention Services (EIS) had a DUP exceeding 6 months, the greatest contribution to DUP coming from delays within mental health services, followed by individual help-seeking delays.

In particular, where first contact with the mental health services was an adult generic community mental health team or child and adolescent services, this predicted longer mental health service delay, longer overall DUP and delayed access to early intervention in psychosis teams (EIS). Modelling the impact of reducing these delays showed that mental health service delay has potentially the greatest impact on reducing DUP.

These findings suggested that in order to have an impact on DUP, help-seeking delays and delays within mental health services (including access to EIS) need to be addressed. This rationale has underpinned the development of our quasi-experimental public health trial to reduce DUP in the South of Birmingham.

Reducing DUP in the South of Birmingham Trial

Our campaign to improve DUP in Birmingham was launched in January 2012 and will run for 18 months. The trial involved two key actions:

1. Providing direct access to a new youth-focused clinical team
2. Implementing a psychosis awareness campaign ‘Don’t turn your back on the symptoms of psychosis’

The new youth-focused clinical team runs alongside existing CMHTs but enables direct referral channels and immediate assessments for all young people presenting to primary care with mental health difficulties, aged 14–25.

The campaign aims to improve the help-seeking of young people and their carers through provision of information, resources about when, where and how to seek help, mental health training and access to a helpline and bespoke website

Hypothesis and Relevence

We hypothesise that our psychosis awareness campaign, in combination with the introduction of the youth focused clinical access team, will significantly reduce DUP. We also predict an increase in referrals of young people diagnosed with a psychotic disorder from the intervention area into EIS.

This pragmatic trial will be the first to target known delays within the care pathway for those with a first episode of psychosis. If successful, this will provide a generalizable methodology that can be implemented in a variety of healthcare contexts with differing sources of delay.