Reducing the Duration of Untreated Psychosis through Community Education

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DESCRIPTION (provided by applicant): Most informational campaigns to reduce the duration of untreated psychosis (DUP) have been unsuccessful. Moreover, there has been little attention given to high-risk, culturally diverse groups. The overall objective of this application is to strengthen the effectiveness of informational campaigns by bringing more scientific rigor to their development and by extending their reach through sustainable campaigns for diverse, high-risk communities. Spanish-speaking adolescents and adults (ages 15-64) residing in a high density (>80%) Latino (largely Mexican origin) community within Los Angeles County will serve as the target group. This group is at high risk for DUP given its low rates of mental health service use and its large proportion of immigrants because immigrants have elevated incidence rates of psychotic disorders. To achieve the overall objective, a multi-level and multi-platform Spanish language Communication Campaign (CC) will be carried out (a) to increase the psychosis literacy of Spanish-speaking adolescents and adults; (b) to reduce the DUP for Latinos with first-episode psychosis (FEP), and (c) to explore the relationship between DUP and the psychosis literacy of individuals with FEP and their caregivers. Embedded in the multiple media formats is the central message: "Use La CLAve (the clue) to detect serious mental illness in your loved ones", a message that has been shown in preliminary studies to increase psychosis literacy. La CLAve is both an acronym and mnemonic device to help people remember the key symptoms of psychosis. To enhance the sustainability of the CC, multiple levels of the community (individuals, care facilitators, community resources, and the mental health institution) will be administered the program, master copies of the informational campaign will be distributed to key community personnel, and community personnel will be trained to administer key aspects of the CC. To assess the penetration and sustainability of the IC, surveys will be conducted of representative households (N = 500 for each wave) at three time points: baseline, 18 months and 36 months. An increase and maintenance of psychosis literacy is expected over the 3-year period. To assess whether there is a reduction of DUP, intake workers at San Fernando Mental Health Clinic will identify the DUP for all incoming Latino patients with FEP over a 4-year period. Based on incidence rates of psychotic disorders and the population of the targeted community, 60 Latino patients with FEP are expected each year (N = 240). Compared to a 1-year baseline, the DUP is expected to decrease significantly over the next 3 years. To explore the relationship of individual's DUP and psychosis literacy, the psychosis literacy and referral sources of all new FEP patients and their caregivers will be among the relevant variables that are examined. The proposed research program has the potential to lead a second generation of DUP reduction programs, one that has a strong evidence base and that reaches many in need, including those underserved groups with high risk for prolonged DUP.