Improving access to specialized care for first-episode psychosis: an ecological model

Aubrey M Moe,¹ Ellen B Rubinstein,² Colin J Gallagher,³ David M Weiss,⁴ Amanda Stewart,¹ Nicholas JK Breitborde<sup>1

1</sup>Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; ²Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA; ³Department of Psychological Sciences, Kent State University, Kent, OH, USA; ⁴Department of Psychology, The Ohio State University, Columbus, OH, USA

Abstract: Psychotic spectrum disorders are serious illnesses with symptoms that significantly impact functioning and quality of life. An accumulating body of literature has demonstrated that specialized treatments that are offered early after symptom onset are disproportionately more effective in managing symptoms and improving outcomes than when these same treatments are provided later in the course of illness. Specialized, multicomponent treatment packages are of particular importance, which are comprised of services offered as soon as possible after the onset of psychosis with the goal of addressing multiple care needs within a single care setting. As specialized programs continue to develop worldwide, it is crucial to consider how to increase access to such specialized services. In the current review, we utilize an ecological model of understanding barriers to care, with emphasis on understanding how individuals with first-episode psychosis interact with and are influenced by a variety of systemic factors that impact help-seeking behaviors and engagement with treatment. Future work in this area will be important in understanding how to most effectively design and implement specialized care for individuals early in the course of a psychotic disorder.

Keywords: first-episode psychosis, early intervention, social ecology, emerging adulthood