Duration of care in Early Intervention in Psychosis services: a multi-perspective qualitative study

Duration of care in Early Intervention in Psychosis services: a multi-perspective qualitative study | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 27 November 2025 V1 Latest version Share on Duration of care in Early Intervention in Psychosis services: a multi-perspective qualitative study Authors : Michelle Rickett 0009-0001-2503-9951 [email protected] , Tom Kingstone , David Shiers 0000-0003-2531-5837 , Paul French , Belinda Lennox , Mike Crawford , Ryan Williams , Jonathan Woodward , and Carolyn Chew-Graham Authors Info & Affiliations https://doi.org/10.22541/au.176425036.60651734/v1 230 views 170 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Introduction Early Intervention in Psychosis (EIP) services in England are commissioned to provide up to three years’ support to people experiencing first episode psychosis, but the optimal duration remains debated. This qualitative study aimed to explore how decisions about EIP duration are made and experienced by multiple stakeholders. Methods Qualitative longitudinal study comprising semi-structured interviews with EIP Service Users (SUs), carers, EIP practitioners, GPs, and mental health service commissioners; follow-up interviews with SUs 6-11 months later. Data were collected between September 2022 - September 2024 and informed by information power. Data were thematically analysed by a multidisciplinary team. Patient and carer involvement and engagement was integral to the study. Results The three-year time limit of contact with EIP teams was thought to work well when SUs felt supported and ready for discharge, but constrained shared decision making when they did not. Some participants described early discharge before three years, either as a negotiated decision based on wellness and readiness to move on or as a consequence of poor engagement. Others reported extended care beyond three years in response to individual needs or delays in transfer to Community Mental Health Teams (CMHTs). This flexibility in duration varied across teams and trusts. Well managed, relational care was viewed as key to effective discharge. Conclusion Flexible, person-centred episodes of care and collaborative discharge planning, supported by effective coordination between EIP, primary care, and CMHTs, are essential to sustaining relational practice and ensuring smoother transitions. Duration of care in Early Intervention in Psychosis services: a multi-perspective qualitative study Authors Michelle Rickett (Keele University); Tom Kingstone (Keele University); David Shiers (Keele University); Paul French (Pennine Care NHS Foundation Trust); Belinda Lennox (University of Oxford); Mike Crawford (Imperial College, London); Ryan Williams (Imperial College, London); and Carolyn Chew-Graham (Keele University) Acknowledgements We would like to thank all interview participants for their time. Thank you to members of the EXTENDing team for their contribution to the EXTEND qualitative study, particularly their input to data analysis. Abstract Introduction Early Intervention in Psychosis (EIP) services in England are commissioned to provide up to three years’ support to people experiencing first episode psychosis, but the optimal duration remains debated. This qualitative study aimed to explore how decisions about EIP duration are made and experienced by multiple stakeholders. Methods Qualitative longitudinal study comprising semi-structured interviews with EIP Service Users (SUs), carers, EIP practitioners, GPs, and mental health service commissioners; follow-up interviews with SUs 6-11 months later. Data were collected between September 2022 - September 2024 and informed by information power. Data were thematically analysed by a multidisciplinary team. Patient and carer involvement and engagement was integral to the study. Results The three-year time limit of contact with EIP teams was thought to work well when SUs felt supported and ready for discharge, but constrained shared decision making when they did not. Some participants described early discharge before three years, either as a negotiated decision based on wellness and readiness to move on or as a consequence of poor engagement. Others reported extended care beyond three years in response to individual needs or delays in transfer to Community Mental Health Teams (CMHTs). This flexibility in duration varied across teams and trusts. Well managed, relational care was viewed as key to effective discharge. Conclusion Flexible, person-centred episodes of care and collaborative discharge planning, supported by effective coordination between EIP, primary care, and CMHTs, are essential to sustaining relational practice and ensuring smoother transitions. Keywords Delivery of healthcare; discharge planning; patient care; psychotic disorders; qualitative methods; severe mental illness Introduction Early Intervention in Psychosis (EIP) services offer multidisciplinary treatment in the community to people experiencing a first episode of psychosis. The lifetime prevalence of psychosis is estimated at 4 per 1000 of the population 1. Psychosis can have wide-ranging and profound implications for individuals’ quality of life, including effects on physical health, cognition, social functioning, social inclusion, education, and employment 2,3 . Schizophrenia and other psychotic disorders are major contributors to the global burden of disease, accounting for around £2 billion per annum in NHS expenditure 4,5 . In the United Kingdom (UK), EIP services offer a three-year package of treatment. The rationale for this time-limited model is that early intensive treatment could preclude the need for such intensive treatment on an ongoing basis (i.e. a secondary prevention approach) 6,7 . However, National Institute for Health and Care Excellence (NICE) 2020 guidance (CG178) recognise that 2–3-years of interventions is not optimal for everyone and some may benefit from extended time under EIP to consolidate improvement that has been achieved 8 . This qualitative study aimed to understand and contextualise the duration of EIP care provided - including individual variation, differences in processes of care, discharge planning and shared decision-making - from the perspectives of service users (SUs), carers, healthcare practitioners and commissioners. This was part of the National Institute for Health and Care Research (NIHR) programme “EXTEND: personalised care for early psychosis,” which explored the impact of EIP duration on service user outcomes. 9 Methods We conducted in-depth, semi-structured interviews with EIP SUs, carers and healthcare practitioners, General Practitioners (GPs) and commissioners of mental health services. SUs and carers were recruited using both purposive and convenience sampling. Potential participants were identified by EIP teams within Mental Health Trusts (MHTs) across England, or self-identified by responding to a study flyer shared via social media (XR), mental health networks, support groups and charities. EIP practitioners and managers were identified through participating MHTs; and GPs and commissioners were identified through professional networks and snowballing. 10 Topic guides were developed by the qualitative research team, alongside lived experience co-investigators and our patient and carer advisory group, ‘EXTENDing’. Topic guides for all four groups of interviews explored experiences and views of EIP services; duration of care; and discharge planning and decision-making. The topic guide for SU follow-up interviews focused on care after discharge; support needs and gaps; and additional reflections on EIP. The guides were modified iteratively alongside data generation and analysis. Data collection was informed by information power; an alternative concept to saturation in qualitative research that involves pragmatic judgements based on aims, specificity, theory, dialogue and analysis. 11 We took a reflexive thematic approach to analysis, which involved reading and re-reading transcripts, generating and organising codes, and constructing themes. 12 Transcripts were grouped and analysed by participant type initially, then cross-cutting themes were generated. The lead researcher (MR) coded the data, led analysis and met regularly with team members representing a range of disciplinary backgrounds, to refine interpretation and agree on the key themes. PPIE Patient and carer involvement and engagement were integral to our research process. We met regularly with our two EXTEND PPI co-investigators and the EXTENDing group who co-designed topic guides and public-facing documents, advised on recruitment strategies and helped to identify, clarify and deepen findings during analysis-focused meetings with the research team and via email feedback. Results We conducted semi-structured interviews with sixteen SUs at, or soon after discharge; fourteen carers; twenty-four EIP practitioners; eight GPs; and six mental health commissioners. Twelve SU follow-up interviews were conducted: eleven of these were conducted 6-8 months after first interview and one SU was re-interviewed a second time at 11 months post-discharge, after delayed discharge to a CMHT. Interviews lasted between 20 and 50 minutes and were conducted online or by telephone. Table 1 – SU demographics Table 2 – Carer demographics Table 3 – GP background Table 4 - EIP practitioners/manager/commissioner background Our findings are reported under four key themes: time-limited care; flexible approaches - early discharge; flexible approaches - extended care; managed transition. Illustrative quotes are presented with participant identifiers (e.g., SU3). Time-limited care Most SUs reported having received the standard three years’ EIP care. SUs felt that this worked well when discharge was planned collaboratively, care coordinators were supportive, and they felt ready, prepared and equipped with the tools they needed to manage independently. I think the length is just right. I don’t think there is anything more that I feel that they can offer me. They’ve given me all the tools to sort of help myself as well. (SU8) However, the time-limited approach was seen as a barrier to shared decision-making for those who didn't feel ready for discharge, leading some to describe feelings of disempowerment and abandonment. She’s just a bit of flotsam in the system as far she’s concerned, I think. I mean they did try and involve her in all decision-making but when the decision is – ‘You’re leaving us and you’re going to the CMHT,’ and there’s no decision to be made and there’s no choice - you can flannel and you can dress it up, but it is what it is. (CAR4) HCPs, SUs and carers felt that strict adherence to the three-year limit could risk relapse for some people due to the loss of the relationship with the care coordinator and less intensive care, as well as loss of progress made during EIP: The people that are coming up to that three years they’re relapsing and I don’t know whether because the safety net’s been taken away. (HCP4) It’s like a weird feeling it’s been so long just having someone there as like a bit of a comfort blanket and then all of a sudden they’re not going to be there anymore and you just think oh no… And then (care coordinator) used to think that it may have been something to do with me having another breakdown (after discharge), knowing that I was losing that support, as well as a number of other things. (SU2) Related to this, most EIP managers and commissioners identified the tension between resource/caseload pressures and responding to individual need. I think that there’s been times when people have been moved on when we could probably justify keeping them for longer, but again it’s that tension between if it sets a precedence… then if that becomes the norm that then has an impact on caseload size. (HCP1) Flexible approaches: early discharge Participants reported that some SUs were discharged from EIP before three years, usually through negotiated agreement between SUs and EIP practitioners, reflecting wellness and readiness, access to and completion of therapies, or personal preference. In these cases, early discharge was experienced positively: It feels like there’s a sense of like we got as far as we can get to at this stage with people. Maybe they recovered, maybe they’ve stopped taking meds, maybe they’re continuing and happy to be taking medication They might’ve had therapy, might not have felt they needed that. Maybe they’re back at work. …So I guess in a lot of cases I like to think that’s probably quite negotiated. (HCP12) Conversely, some early discharges resulted from lack of engagement and challenges in relationship-building. They stop engaging or they don’t really engage, got quite an avoidant, you know, style I guess often times it’s over-represented in psychosis isn’t it? I think people are more withdrawn at times so yeah is there that engagement issue. (HCP17) One GP voiced frustration about the decision to discharge SUs due to non-engagement, suggesting that ‘ not engaging is probably a sign that they’re unwell, not a sign that all is hunky-dory.’ (GP6) : Flexible approaches: extended care Capacity and waiting lists One of the most common reasons for extending EIP care beyond three years, cited by EIP HCPs, was lack of capacity in receiving CMHTs. SUs who were not felt to be suitable for discharge to primary care remained under EIP care awaiting transfer: So obviously if someone has ongoing support needs they can’t be discharged back to primary care and (if) we can’t transfer them to a relevant team, then we can’t discharge them. So, they will have to stay under us. (HCP13) The uncertainty surrounding these delays could feel worrying and destabilising for SUs and carers: It doesn’t feel very secure and safe. Everything is just up in the air at the minute. I’ve felt quite anxious about it. (SU3 follow up interview) Personalised approaches to extending care Most EIP HCPs felt that some SUs would benefit from extended care under EIP, but this was often not possible due to the time-limited approach. There was definitely a group of people who at that three-year point looked like they had the potential for more recovery, if they had the same level of input that we’re providing them. But we’re only funded to three years. (HCP13) Care was occasionally reported to be extended in practice, often through the advocacy and experience of care coordinators, who could play an important role in decision-making: I’ve got a bit of a reputation, I do. So, I mean, obviously I’ve been around a long time in the team, so I’ve probably got more examples to draw on (of extending care) than others have. I’ve had a couple where I’ve fought for them to be extended, for various reasons…Just things that come up that you think, ‘Oh, I couldn’t possibly discharge her now, this is not a good time,’ …. (HCP20) EIP care was sometimes extended to allow completion of EIP therapies, which could be delayed by waiting lists or SUs only being ready to engage with therapies towards the end of the three years: I think if there’s a justification to extend somebody because they might not have been able to access part of the full EI care package for whatever reason, and that person was ready and willing to be engaged in that, and then we think that that would be of benefit to them then they’ll extend their care. (HCP1) SUs who were particularly unwell or unstable were also reported to stay under EIP beyond three years to avoid exacerbating their symptoms: Well, there were several times they felt he was still too ill to move on. And then they really were going to move him and then COVID and that really got in the way. So, they kept him all that time and then he ended up ill again in hospital. So, it’s just been extended and extended. (CAR7) Significant life events and social factors (e.g., pregnancy, bereavement, changes in work/education, housing crises) could lead to delayed discharge from EIP service for some people: As I was due to be discharged and transferred to the community mental health team, I was pregnant and…my due date kind of postponed it and they wanted to keep an eye on me because of the risk you know, postpartum. So, yes, that’s the reason why like I have been allowed that extension. (SU3) So, we’ve had somebody recently who was due to be discharged a couple of months ago, but they had a housing crisis at that time. …so we agreed to kind of continue to support for a period of time…(HCP3) Some teams extended care for reasons related to neurodiversity – e.g. to facilitate formal assessment or to ease the transition to other services. She was not too far away from coming up to the three-year period when we kind of put everything together and wondered whether she might be on the autistic spectrum. So, she was referred for an assessment, she agreed to that, and the service here… agreed to fast track her assessment while she was involved with services. So that delayed her service by about four or five months, while we kind of got through that process and supported her with that, and she was given a diagnosis of autism. (HCP20) This personalised approach was appreciated by SUs with neurodiverse conditions: They’ve been making sure that I’m not getting too overwhelmed about it. I have been able to ask questions. I’m not really good with change, so they’ve been taking it slow with us, which I’m really grateful for. (SU6) However, in other cases, SUs with suspected neurodiverse conditions were discharged at three years and then struggled to receive timely assessment and support. I had two care coordinators. The first one said, ‘I did suspect you probably (have autism), but I’m not too sure’ and that wasn’t really taken that far and then she left basically. And then the new care coordinator took over and then straight away just said, ‘Yeah, I’m making you a referral’ and I’ve literally been waiting about three and a half years for it. So, it was only the other week that I’ve actually had (the diagnosis). So that’s a good year and a bit out of the care of the early intervention team. (SU13) In a minority of cases, duration of EIP care was reported to be extended due to collaborative decision making by care coordinators and SUs. This helped SUs feel supported and listened to. I think the reason (for the extension) was there was lots of change going on and also they felt that I needed it…More importantly, I felt that I needed it as well. I felt that they did listen to me and responded very appropriately and very positively ” (SU16) Some HCPs expressed a desire for more transparent procedures to formalise such decisions: I mean, length of care, I would love for there to be a kind of an agreed facility to do this for those people that you do feel need a bit longer…. if I had known we could’ve offered another year, then I could’ve said, ‘Let’s extend it for a year, this is going to be your new date, that’s what we’re working towards in that piece of time’ When extending care isn’t enough…. Some carers of SUs with severe, enduring illness felt that even extending EIP care wasn’t enough, and that their loved ones needed ongoing high levels of support and rehabilitation that weren’t adequately provided when they were discharged to CMHTs: If somebody’s got a diagnosis of schizophrenia, which is lifelong, that’s very different to somebody that’s experiencing a one-off psychosis. She needs long-term support. (CAR11) HCPs also felt that some SUs with severe symptoms and complexity needed more than an extension of care: If you are from…socially oppressed, social economic, cultural background or you have a complex sort of neurodevelopmental conditions as well intermixed with that then you’re often spending that three years just trying to get over the first hurdle to get them engaged in that process…You get this kind of like intense group of people that need much more support and I think they are a lot of the patients that are revolving door admission patients and needing assertive outreach and needing that kind of, that more push of engagements, really… it’s probably kind of a combination of assertive outreach and extension that’s needed (HCP6) Managed transition SUs, carers and EIP HCPs all felt that the close, supportive relationships formed within EIP were key to its success: The relationship and the attachment they have to us as the service and clinicians is that kind of key bedrock of what helps people. (HCP17) The EIP team…especially the care coordinator…they get to know you, your family setup and everything. I think that, for me, was really important as well. Just understanding that I’m more than what I’ve just been through…Just make you feel like you’ve got that hope that you are going to get better. (SU1) SUs and carers expressed concern about the loss of these relationships, which would not be replicated after discharge. This was an issue irrespective of duration of care: It’s been so long just having someone there as like a bit of a comfort blanket and then all of a sudden they’re not going to be there anymore…so obviously not having that there was pretty worrying. (SU2) One carer felt that a ‘gentler transition’ (CAR8) would have led to a more positive experience of discharge for him and his loved one. Discussion Our research found substantial variation across EIP teams in how flexibly the three-year period of care is applied. Decisions to extend care are influenced not only by clinical need but also capacity and caseload pressures within EIP and CMHTs, as well as care coordinator expertise and advocacy. This suggests that SUs and carers can experience inequitable access to extended care and inconsistent pathways. Person-centred, relational care is key to the EIP model and this cannot be fully achieved if there is lack of flexibility or shared decision making in relation to duration of care. Many EIP HCPs feel that there are circumstances in which extended care can improve SU outcomes and experiences both within EIP and after discharge. SUs and carers reported positive experiences when extensions were negotiated and responsive to individual needs and circumstances. However, the absence of formal guidelines leaves such decisions dependent on local discretion and judgment. For some SUs with more severe illness, an extended period of EIP still does not meet their needs. Strengths and limitations Our study incorporated perspectives from diverse participants and involved people with lived experience throughout the research process. The use of information power to aid data collection added rigour to our analysis, ensuring that we focused on generating the optimal volume, quality and specificity of data to answer our research questions. Only three of the sixteen SUs interviewed were discharged to CMHT and just over half were women, which may not fully reflect the EIP population. Further research exploring the experiences of male SUs and those discharged to CMHTs would be important. SUs with severe symptoms were less likely to participate in this research. However, several carers reported that they provided care for people with severe illness and gave insight into these experiences. Comparison with literature We believe this is the first qualitative study to examine how EIP duration of care and discharge are negotiated and experienced in practice, from the perspectives of SUs, carers and healthcare practitioners. It reinforces previous qualitative studies on SU experiences of discharge from EIP, highlighting the centrality of relational care within EIP and the sense of loss SUs can feel when losing these relationships as well as the need for advance planning 13-15, Previous research has also shown that continuity of care within EIP and strong relationships with care coordinators lead to improved outcomes 16-18 The literature shows that there are a range of illness trajectories following a first episode of psychosis, and a significant proportion of people do not reach remission nor recovery criteria after their FEP. 19 Our carer narratives in particular highlight the challenges of navigating care and discharge for SUs with ongoing severe symptoms. Evidence suggests that early access to psychiatric rehabilitation can be beneficial for this group, but we found little evidence of this being offered 20 Previous literature suggests that there is unmet need for people who have a first episode of psychosis and suspected neurodivergence 21 . Our research shows that personalised approaches to duration of care and discharge are particularly impactful for this group of SUs. Conclusion This research highlights the benefits of personalising EIP duration of care to improve patient experiences and outcomes, and identifies circumstances where extended care has positive impact. We suggest that collaborative decision-making and planning around discharge from EIP and continuity of care post-discharge are key to achieving optimal experiences for SUs and carers, irrespective of the duration of formal EIP involvement. In terms of implications for practice, we suggest that relational care should be promoted through planned, supported discharge processes, including shared care protocols and clear communication between EIP, primary care and CMHTs. Practitioners should promote consistency in decision-making about duration and discharge planning, including considering specific cases where transition needs may differ. SUs and carers should be actively involved in planning and decision making. Ethics statement Research ethics approval was obtained in September 2022 from the North of Scotland Research Ethics Committee (reference: 22/NS/0113) and Health Research Authority (Integrated Research Application System ID: 313927). Funding statement This study/project (EXTEND: Personalised Care for Early Psychosis: https://www.psych.ox.ac.uk/research/extend) is funded by the National Institute for Health and Care Research (NIHR) under its Programme Grants for Applied Research (reference: NIHR203277). Chew-Graham is part-funded by the NIHR Applied Research Collaboration West Midlands. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. References 1. Kirkbride, J. B., Jackson, D., Perez, J., Fowler, D., Winton, F., Coid, J. W., … & Jones, P. B. (2013). A population-level prediction tool for the incidence of first-episode psychosis: translational epidemiology based on cross-sectional data. BMJ open , 3 (2), e001998 2. Mason, P., Harrison, G., Glazebrook, C., Medley, I., Dalkin, T., & Croudace, T. (1995). Characteristics of outcome in schizophrenia at 13 years. British Journal of Psychiatry , 167 (5), 596-603. 3. Meltzer, H. Y. (2002). Suicidality in schizophrenia: a review of the evidence for risk factors and treatment options. Current psychiatry reports , 4 (4), 279-283. 4. Mangalore, R., & Knapp, M. (2007). Cost of schizophrenia in England. The journal of mental health policy and economics , 10 (1), 23-41 5. Murray, C. J., & Lopez, A. D. (1996). Evidence-based health policy—lessons from the Global Burden of Disease Study. Science , 274 (5288), 740-743 6. Bertolote, J., & McGorry, P. (2005). Early intervention and recovery for young people with early psychosis: consensus statement. The British Journal of Psychiatry , 187 (S48), s116-s119. 7. Morgan, C., Lappin, J., Heslin, M., Donoghue, K., Lomas, B., Reininghaus, U., … & Dazzan, P. (2014). Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study. Psychological medicine , 44 (13), 2713-2726. 8. National Institute for Health and Care Excellence (NICE), 2020. Psychosis and schizophrenia in adults: Prevention and management . NICE Clinical Guideline CG178. Available at: https://www.nice.org.uk/guidance/cg178 [Accessed 25 June 2025]. 9. EXTEND website. https://www.psych.ox.ac.uk/research/extend. (Accessed 25 th July 2025) 10. Noy, C . (2008). The Hermeneutics of Snowball Sampling in Qualitative Research . International Journal of Social Research Methodology , 11(4), 327-344. 11. Malterud, K., Siersma, V. D., & Guassora, A. D. (2016). Sample size in qualitative interview studies: guided by information power. Qualitative health research , 26 (13), 1753-1760 12. Braun, V., Clarke, V., Hayfield, N., et al. “Doing reflexive thematic analysis.” In S Bager-Charleson & A McBeath (Eds), Supporting research in counselling and psychotherapy: Qualitative, quantitative, and mixed methods research (pp. 19-38). Cham: Springer International, 2023 Publishing 13. Loughlin M, Berry K, Brooks J, Bucci S. “Moving on from early intervention for psychosis services: Service user perspectives on the facilitators and barriers of transition,” Early Interv Psychiatry 13, no. 6 (2019):1396-403. 14. Lester H, Khan N, Jones P et al. “Service users’ views of moving on from early intervention services for psychosis: a longitudinal qualitative study in primary care,” Br J Gen Prac 62, no. 596 (2012): 183–190. https://doi.org/10.3399/bjgp12X630070 15. Rickett M , Kingstone T, Gupta V et al. “Navigating discharge from Early Intervention in Psychosis Services: a qualitative exploration of the experiences of Service Users and Carers” Health Expectations 28m no. 4 (2025). https://doi.org/10.1111/hex.70375 1. Williams R, Penington E, Gupta V, et al. Critical components of ‘Early Intervention in Psychosis’: national retrospective cohort study. The British Journal of Psychiatry . Published online 2025:1-9. doi:10.1192/bjp.2025.126 2. Lester H, Birchwood M, Bryan S et al. “Development and implementation of early intervention services for young people with psychosis: case study,” Br J Psychiatry 194, no. 5 (2009):446-50. doi: 10.1192/bjp.bp.108.053587. PMID: 19407276. 3. Adair C, McDougall M, Mitton C et al. (2005). Continuity of Care and Health Outcomes Among Persons With Severe Mental Illness. Psychiatr Serv 56, no. 9: 1061-1069. https://doi.org/10.1176/appi.ps.56.9.1061 4. Lally, J., Ajnakina, O., Stubbs, B., Cullinane, M., Murphy, K. C., Gaughran, F., & Murray, R. M. (2017). Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies. The British Journal of Psychiatry , 211 (6), 350-358. 5. Kuipers E. (2014) Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ (Online) ;348 6. Nikolić N, Sculthorpe C, Stock J, Stevens D, Eccles J. Determining unmet need: clinical relevance of suspected neurodivergence in first-episode psychosis. BJPsych Bulletin. 2024:1-6. Table 1 – SU demographics SU1 Female 31-40 White British Lives with partner and children ü (reinterviewed twice as SU was still waiting to be discharged at first follow up) SU2 Female 21-30 White British Lives alone ü SU3 Female 21-30 White and Black Caribbean Lives with partner and child ü SU4 Female 21-30 Mixed/multiple ethnicity Lives with father ü SU5 Female 41-50 White Polish Lives with partner and child ü SU6 Female 21-30 White British Lives with father ü *SU7 Female 61-70 White British Lives with partner ü SU8 Female 51-60 Black Caribbean Lives alone ü SU9 Male 41-50 Black British Lives with partner x SU10 Female 61-70 White British Lives with partner x *SU11 Male 21-30 White British Lives alone ü SU12 Male 41-50 White British Lives with partner and children x SU13 Male 41-50 White British Lives alone ü SU14 Male 31-40 White British Lives with parents ü SU15 Male 31-40 White British Lives alone x SU16 Male 41-50 White Australian lives with partner x *Dyadic interviews with carer Table 2 – Carer demographics CAR1 Male Brother 21-30 Asian CAR2 Male Friend 21-30 Black British CAR3 Female Niece 21-30 Indian British CAR4 Female Mother 61-70 White British CAR5 Male Husband 51-60 White British CAR6 Male Grandchild 21-30 Black British CAR7 Female Mother 51-60 White British CAR8 Male Partner 61-70 White British CAR9 Female Former partner 41-50 Bangladeshi CAR10 Female Mother 41-50 White British CAR11 Female Mother 41-50 White British CAR12 Female Mother 51-60 White British CAR13 Female Mother 61-70 White British CAR14 Female Daughter-in-law 31-40 White Other (Italian) *Dyadic interviews with SU. Table 3 – GP background GP1 Female 10 Inner city GP2 Male 5 Urban GP3 Male 5 years as partner Rural GP4 Female 25 Participant worked across several practice in different locations GP5 Male 11 years as partner Suburban GP6 Female 19 Urban GP7 Female 13 Semi-rural GP8 Female 4 Urban Table 4 – EIP practitioners/manager/commissioner background HCP1 Female Clinical Lead, Early Intervention in Psychosis HCP2 Female EIP Team Manager HCP3 Female EIP Team Manager HCP4 Female Care co-ordinator/Mental Health Nurse HCP5 Male Consultant Psychiatrist HCP6 Male Advanced Clinical Practitioner/Social Worker HCP7 Female Care co-ordinator/Mental Health Nurse HCP8 Female Community psychiatric nurse HCP9 Male Consultant Psychiatrist HCP10 Male Consultant Psychiatrist HCP11 Female EIP Team Manager HCP12 Male Psychologist HCP13 Male Case manager HCP14 Male EIP Team Manager HCP15 Female Clinical Nurse specialist HCP16 Female EIP Team Manager HCP17 Male Principal Psychologist HCP18 Female Principal Psychologist HCP19 Male Community Psychiatric Nurse HCP20 Female Clinical Lead, Early Intervention in Psychosis HCP21 Female Care co-ordinator/Mental Health Nurse HCP22 Male Community Psychiatric Nurse HCP23 Female Peer support worker COM1 Male Senior Programme Manager COM2 Male Senior Programme Delivery Lead COM3 Female Associate Director for Specialist Services COM4 Female Senior Transformation Manager, Mental Health COM5 Female Interim Head, Mental Health, Learning Disabilities and Autism COM6 Female Trust EIP Lead Information & Authors Information Version history V1 Version 1 27 November 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords delivery of healthcare patient care psychotic disorders qualitative methods severe mental illness Authors Affiliations Michelle Rickett 0009-0001-2503-9951 [email protected] Keele University View all articles by this author Tom Kingstone Keele University View all articles by this author David Shiers 0000-0003-2531-5837 Keele University View all articles by this author Paul French Pennine Care NHS Foundation Trust View all articles by this author Belinda Lennox University of Oxford View all articles by this author Mike Crawford Imperial College London View all articles by this author Ryan Williams Imperial College London View all articles by this author Jonathan Woodward University of Sheffield View all articles by this author Carolyn Chew-Graham Keele University View all articles by this author Metrics & Citations Metrics Article Usage 230 views 170 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Michelle Rickett, Tom Kingstone, David Shiers, et al. Duration of care in Early Intervention in Psychosis services: a multi-perspective qualitative study. Authorea . 27 November 2025. DOI: https://doi.org/10.22541/au.176425036.60651734/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.176425036.60651734/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a00386bc48744807',t:'MTc3OTUzMzcwNQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();