Quality of individual and group level interventions for first-episode psychosis at the tertiary psychiatric hospital in Uganda

Abstract

Background: Individual and group level interventions have the largest effect on outcomes in patients with the first episode of psychosis. The quality of these individual and group level interventions provided to first-episode psychosis patients in Uganda is unclear. Aim: To determine the quality of the individual and group level interventions provided to first episode psychosis patients in Uganda Setting: The study was performed at the only tertiary psychiatric hospital in Uganda. Methods: A retrospective chart review of recently discharged adult in-patients with the first episode of psychosis was performed. The proportion of participants who received different essential components for individual and group level interventions were calculated. From the different proportions, the quality of the services across the individual and group interventions was determined using the first-episode psychosis services fidelity scale (FEPS-FS). The FEPS-FS assigns a grade of 1–5 on a Likert scale depending on the proportion of patients who received the different components of the intervention. Twelve essential components across the individual and group interventions were assessed and their quality quantified. Results: The final sample included 156 first-episode psychosis patients. The median age was 27 years (inter-quartile range [IQR] [24–36]) and 55% of the participants were female. All 12 essential components had poor quality with the range of scores on the FEPS-FS between one and three. Only one essential component assessed (use of single antipsychotics) had moderate quality. Conclusion: Amongst current services at the Butabika National Referral Mental Hospital in Uganda, the essential components for individual and group level interventions for psychotic disorders are of poor quality. Further studies are required on how the quality of these interventions can be improved.

Keywords

• early intervention services
• low and middle income country
• public health
• service provision
• first episode psychosis
• individual level interventions
• group level interventions