Background:
New South Wales has adopted an early psychosis (EP) program based on research that early intervention improves mental health outcomes. EP ‘flags’ recorded at community contacts are reportedly underused, making it difficult to analyze EP pathways and outcomes. This study aims to measure the number of first-episode psychosis cases in 2004-2005, examine the performance of the EP flags and investigate differences in service utilization.
Methods:
Cases were identified based on their recorded contacts with community mental health teams between July 2003 and June 2005. The observed incidence was compared with recently published treated incidence rates through indirect standardization. The sensitivity of the EP flags for identifying cases was calculated. Service utilizati on, as measured by treatment days per quarter, was compared between EP clients and other groups.
Results:
There were 2475 cases identified in 20042005, which is 40% higher than expected. The EP flags failed to identify these cases (sensitivity 7%-39%). Psychosis clients had a significantly higher level of service utilization: clients with a prior psychosis diagnosis had the highest mean treatment days (7.7), followed by first-episode psychosis (6.5), bipolar/mania (5.7) and other diagnoses (3.5). These differences persisted after controlling for age and AHS (P < 0.001 for all contrasts).
Conclusions:
The incidence of first-episode psychosis was higher than expected possibly because of inconsistencies in diagnostic recording in 2003–2004. The EP flags are underused and fail to identify clients with first-episode psychosis, whose service utilizations differs from other clients.
