Reducing the Duration of Untreated Psychosis in the United States (R34)

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Approximately 100,000 adolescents and young adults in the United States experience a first episode of psychosis (FEP) every year. The early phase of psychotic illness is widely viewed as a critical opportunity for indicated prevention, and a chance to alter the downward trajectory and poor outcomes associated with serious mental disorders such as schizophrenia. Multi-element FEP specialty care programs can produce a range of positive clinical and functional outcomes. The timing of treatment is critical; short and long-term outcomes are better when individuals begin treatment close to the onset of psychosis. Numerous studies find a substantial delay between the onset of psychotic symptoms and the initiation of treatment; in the U.S. treatment is typically delayed between one and three years, suggesting that many FEP persons are missing a critical opportunity to benefit from early intervention. Early identification, rapid referral to specialty FEP care, and engagement in phase-specific treatment are essential to shortening the duration of untreated psychosis (DUP) and pre-empting functional deterioration. The World Health Organization advocates reducing DUP to 3 months or less by addressing bottlenecks in the pathway from early psychosis identification to initiation of specialty care. Accordingly, this Funding Opportunity Announcement (FOA) will support R34 grants that (1) identify a baseline rate of DUP in community treatment systems that include evidence-based specialty care programs for FEP; (2) map referral pathways to FEP care, (3) identify gaps and bottlenecks in the referral pathway, and (4) develop and pilot test feasible strategies for substantially reducing DUP among persons with FEP.

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