Pathways to care in subjects at high risk for psychotic disorders - A European perspective

Heinrich Graf von Reventlow, Seza Krueger-Zguerdal, Stephan Ruhrmann, Frauke Schultze-Lutter, Andreas Heinz, Paul Patterson, Markus Heinimaa, Peter Dingemans, Paul French, Max Birchwood, Raimo K. R. Salokangas, Don Linszen, Anthony Morrison, Joachim Klosterkoetter, Georg Juckel*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Evidence-based decisions on indicated prevention in early psychosis require large-scale studies on the pathways to care in high-risk subjects. EPOS (The European Prediction of Psychosis Study), a prospective multi-center, naturalistic field study in four European countries (Finland, Germany, The Netherlands and England), was designed to acquire accurate knowledge about pathways to care and delay in obtaining specialized high risk care. Our high risk sample (n = 233) reported on average 2.9 help-seeking contacts, with an average delay between onset of relevant problems to initial help-seeking contact of 72.6 weeks, and between initial help-seeking contact and reaching specialized high risk care of 110.9 weeks. This resulted in a total estimated duration of an unrecognized risk for psychosis of 31/2 years. Across EPOS EU regions, about 90% of care pathway contacts were within professional health care sectors. Between EPOS regions, differences in the pathways parameters including early detection and health-care systems were often very pronounced. High-risk participants who later made transition to a full psychotic disorder had significantly longer delays between initial help-seeking and receiving appropriate interventions. Our study underlines the need for regionally adapted implementation of early detection and intervention programs within respective mental health and health care networks, including enhancing public awareness of early psychosis.
Original languageEnglish
Pages (from-to)400-407
JournalSchizophrenia Research
Issue number2-3
Publication statusPublished - Feb 2014


  • Pathways to care
  • Early psychosis
  • High-risk
  • Mental health care services

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