Identifying and managing people with an at-risk mental state for psychosis

  • 20th April 2023

Clinical guidelines about providing early support to patients with an at-risk mental state for psychosis might not be being met, suggests research published in Early Intervention in Psychiatry. Researchers at the NIHR Bristol Biomedical Research Centre and the Centre for Academic Primary Care at the University of Bristol identified high thresholds for accessing treatment and limited treatment availability as barriers to successful guideline implementation.

People with an at-risk mental state (ARMS) are seen as being at risk of developing psychosis because of some of the symptoms they may be experiencing. The National Institute for Health and Care Excellence (NICE) recommend that people with ARMS should be referred to Early Intervention (EI) teams or other specialised services for assessment and treatment. This is because intervening early can prevent psychosis from developing.

However, the researchers found that referring or getting people assessed by an EI team is a complicated process. This may be due to several factors:

  • Potential difficulties in identifying ARMS patients
  • The context within which symptoms of psychosis developed
  • High thresholds for accessing secondary care services
  • Potentially limited treatment availability

Overall findings suggested that many people who could potentially meet the threshold for ARMS are either not seen by EI teams or not being offered specialist treatment. Researchers interviewed:

  • Patients
  • GPs, as they are the initial point of contact for people wanting to access mental health services
  • Clinicians from Primary Care Liaison Services (PCLS), as they triage the GP referrals
  • Clinicians from the Early Intervention Teams, as they offer assessment and treatment to patients with ARMS.

Dr Daniela Strelchuk, lead author, said: “Improving GPs’ and PCLS clinicians’ understanding of the early symptoms of psychosis could be an important step to improving the identification of ARMS patients.

“Whilst GPs and PCLS clinicians should be encouraged to refer all patients who have distressing psychotic symptoms to specialised services, regardless of the context in which the symptoms developed, greater investment in ARMS services is required for them to be able to provide treatment as recommended by NICE guidelines.”

Read the paper

The identification and management of people with an at-risk mental state (ARMS) for psychosis in primary and secondary care services: A qualitative interview study. Daniela Strelchuk, Nicola Wiles, Catherine Derrick, Stan Zammit, Katrina Turner. Published in Early Intervention in Psychiatry. April 2023.