A systematic, confidential approach to improving community care for patients with non-affective psychosis

The objective of this study was to determine and compare the service standards for patients with psychotic illness between those known and unknown to secondary services and those living in urban and rural areas. Patients aged 18-64 years diagnosed with non-affective psychosis and who had received anti-psychotic medication in the previous 2 years were identified. A standard search of general practitioner (GP) databases created practice-based anonoymized registers. Demographic details and markers of care were noted and analysed without patient-identifying information. The study was situated in general practices in Eastern England. A total of 19 general practices with a population of 167 405 participated. The main outcome measures were evidence of mental health reviews or written care plans. There were 293 patients identified, which was an overall prevalence rate of 1.75 in 1000. Ninety-five percent of the patients were aged 26 years or over and were evenly distributed across the age groups. Despite 65% having had a recent mental health review, only 47% of the patients had written care plans with significantly more urban than rural patients having care plans filed in their GP records. Significantly more patients from urban areas had contact with secondary mental health services than those from rural areas (P < 0.01). Patients who had contact with secondary services were more likely to have care plans (P < 0.001) and reviews at intervals of 6 months (P < 0.001). It was concluded that this system is pragmatic and effective. It provides a confidential, structured way of planning and coordinating community care for everyone suffering severe mental illness, particularly those not accessing secondary services. This approach should be developed to include other mental illnesses.