Mobile Detection and Engagement One Solution to Delay and Poor Access

The barriers to early detection described above can be overcome. The Youth Access Team (YAT) at EPPIC provides one example of how entry to care, initial assessment and engagement of patients, as well as home-based care and assertive outreach, can be provided. Although YAT is part of a comprehensive early psychosis programme, this model can be successfully introduced within more generic service systems. For example, a similar model operating in Stavanger, Norway, the early detection (ED) team, has helped to reduce the duration of untreated psychosis dramatically [31].

YAT is a multidisciplinary mobile assessment, crisis intervention and community treatment team [1,43]. It operates 24 hours a day, 7 days a week to provide assessment for young people aged 15-29 years who present with a suspected first episode of psychosis. Whenever required, it also provides intensive home-based treatment for patients and families with early psychosis.

YAT is the first point of contact for all young people and referrers seeking help, providing a triage service. Referrals are accepted from any source, with the majority received by telephone. Possible outcomes from the telephone triage system include provision of information, referring to more appropriate agencies, allocation to the YAT team for non-urgent further assessment, or organization of an urgent assessment.

After receiving basic details, if there is a reasonable suspicion that the individual is experiencing emerging psychosis, then the person is accepted for further assessment. The philosophy is inclusive, rather than exclusive. It is considered preferable to assess all young people who may have a psychosis, in order to identify as many true cases as possible, even if this involves seeing many with other psychiatric disorders. This roughly translates into a ratio of 2:1, i.e. total cases seen:cases with ''true positive'' first-episode psychosis.

The flexibility of the YAT service allows for monitoring of young people who are not yet in acute crisis. Engagement can occur over several weeks, assisting the young person to recognize the need for treatment and to become motivated to attend regular outpatient appointments. YAT also facilitates alternatives to inpatient admission, for example through assistance with transport to a low-stigma outpatient centre or the provision of home-based treatment in appropriate cases. Young people who may be in the prodromal phase of psychosis are referred to EPPIC's PACE Clinic, a specific programme which provides structured, longer-term follow-up of individuals considered at high risk of progressing to psychotic illness. Several clinics of this type have developed around the world in recent years [44].

Psychoeducation and support for families at such a time of crisis is an essential component during the engagement phase. Information from families can be invaluable in initial assessment and triage. Engagement of families as early as possible will assist in monitoring the patient and providing continuing care, and also facilitate direct support to the family at a time of considerable distress.

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