The association between community and service level factors and rates of disengagement in individuals with first episode psychosis

Introduction: Individuals who experience a first episode of psychosis require early intervention and regular follow-up in order to improve their prognosis and avoid long-termnegative outcomes. However, approximately 30% of individuals accessing support will end up disengaging from early intervention (EI) services. Although we know that individual factors can impact rates of disengagement, less is known about potential service and community level factors. Methods: Data were gathered from a cohort of individuals attending a specialist youth mental health service in Melbourne, Australia between 1st January 2011 and 7th September 2014. Data were collected from clinical files and electronic medical records using a standardised audit instrument. Cox regression analysis was used to identify whether community level factors were predictors of disengagement. Results: Datawere available for 707 young people experiencing a first episode of psychosis. Individuals residing in neighbourhoods of higher social deprivation were at a higher relative risk of disengaging, with 4.7% increase in engagement for each increase in decile of deprivation. The introduction of a new clinic was not significantly associated with a difference in the proportion of individuals disengaging from the service and distance to service was not significantly associated with disengagement rates. Discussion: Developing strategies focused on engaging young people with first episode psychosis who reside in more deprived areasmay address the higher rates of disengagement these individuals experience. These finding suggest that locationmay not be a barrier to engagement, however services should be resourced in-line with the population demographic in their specific location. (C) 2019 Elsevier B.V. All rights reserved.