Outreach and support in south London (OASIS): implementation of a clinical service for prodromal psychosis and the at risk mental state

• Published in: European psychiatry Vol. 20; no. 5; pp. 372 - 378
• Main Authors: Broome, Matthew R., Woolley, James B., Johns, Louise C., Valmaggia, Lucia R., Tabraham, Paul, Gafoor, Rafael, Bramon, Elvira, McGuire, Philip K.
• Format: Journal Article
• Language: English
• Published: Paris Elsevier SAS 01.08.2005; Elsevier
• Subjects: Adult; Biological and medical sciences; Clinical; Community Mental Health Services - organization & administration; Community Mental Health Services - statistics & numerical data; Community-Institutional Relations; Feasibility Studies; Female; Health Services Accessibility; Humans; London; Male; Medical sciences; Mental health; OASIS; Organization of mental health. Health systems; Patient Satisfaction; Primary Health Care - organization & administration; Primary Health Care - statistics & numerical data; Prodromal; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychosis; Psychotic Disorders - diagnosis; Psychotic Disorders - ethnology; Psychotic Disorders - therapy; Referral and Consultation; Risk; Risk Factors; Service; Social psychiatry. Ethnopsychiatry; Socioeconomic Factors; Urban Health Services - organization & administration; Urban Health Services - statistics & numerical data; United Kingdom; Europe; Psychosis; Clinical; Service; Risk; OASIS; Prodromal; Social environment; Socioeconomic status; Mental health; Health service; Implementation; Prevention; Minority; Prepsychotic state; Public health; Human; Poverty; Treatment efficiency; Ethnic group; Symptomatology; Treatment; First episode; Sociodemographic factor; Follow up study; Adolescent; Young adult; Risk factor; Suburban zone; Feasibility
• ISSN: 0924-9338; 1778-3585
• DOI: 10.1016/j.eurpsy.2005.03.001

Background. – While recent research points to the potential benefits of clinical intervention before the first episode of psychosis, the logistical feasibility of this is unclear. Aims. – To assess the feasibility of providing a clinical service for people with prodromal symptoms in an inner city area where engagement with mental health services is generally poor. Method. – Following a period of liaison with local agencies to promote the service, referrals were assessed and managed in a primary care setting. Activity of the service was audited over 30 months. Results. – People with prodromal symptoms were referred by a range of community agencies and seen at their local primary care physician practice. Over 30 months, 180 clients were referred; 58 (32.2%) met criteria for an at risk mental state, most of whom (67.2%) had attenuated psychotic symptoms. Almost 30% were excluded due to current or previous psychotic illness, of which two-thirds were in the first episode of psychosis. The socio-demographic composition of the 'at risk' group reflected that of the local population, with an over-representation of clients from an ethnic minority. Over 90% of suitable clients remained engaged with the service after 1 year. Conclusion. – It is feasible to provide a clinical service for people with prodromal symptoms in a deprived inner city area with a large ethnic minority population.