Help-seeking in people with early psychosis: A systematic review of the qualitative literature and novel model of facilitators and barriers

Reducing duration of untreated psychosis (DUP) is a priority for mental health services worldwide. Delayed help-seeking leads to prolonged DUP which is associated with poorer healthcare outcomes. Most of the research in this area is qualitative. We conducted an electronic search of relevant databases (MEDLINE, APA PsycArticles, APA PsycINFO, and CINAHL) using terms for early psychosis, help-seeking and qualitative analyses. Following best practice guidelines for reviews of qualitative research, we extracted and thematically synthesised data from all included articles. The search yielded thirty papers. Synthesis of the results generated five domains of facilitators and barriers to help-seeking: (a) knowledge of psychosis and services; (b) role of family and friends; (c) stigma of psychosis and help-seeking; (d) relationship with clinicians; and (e) experience of services. This is the first systematic review of the qualitative research examining first person accounts of help-seeking in high risk and first episode psychosis. We integrate these findings with an established theory of help-seeking to generate a novel model of help-seeking in early psychosis that can now be used to predict engagement and disengagement from services, and shape routine clinical practice to reduce DUP. • We synthesise all qualitative literature on help-seeking in early psychosis. • Knowledge, stigma, and significant others determine initial help-seeking. • Quality of contact, stigma, and key relationships determine ongoing engagement. • We propose a novel model of facilitators and barriers to service engagement. • The model informs practice and policy to reduce duration of untreated psychosis.