Beyond Duration of Untreated Psychosis: Understanding Help-Seeking Pathways to First-Episode Psychosis Care in a Coordinated Specialty Clinic

Background: Duration of untreated psychosis (DUP) is often used to assess early psychosis intervention programs, with shorter DUPs historically associated with better outcomes. However, using DUP as a primary proxy minimizes individual experiences during help-seeking. Objective: To examine specific help-seeking episodes (HSEs) among patients accessing first-episode psychosis (FEP) care, with a focus on a subset whose first HSE led directly to specialized treatment. Methods: Patients at the Early Psychosis Intervention Clinic – New Orleans (EPIC-NOLA) completed the Pathways to Care (PTC) assessment, which included both structured items and narrative responses. Thematic analysis was conducted on patient responses to identify common barriers to care. A subgroup of patients whose first HSE resulted in direct intake at EPIC-NOLA (“EPIC First”) was examined. Results: Among 79 participants, 32 were classified as “EPIC First.” The mean DUP for this group was 18 weeks. Entry into care was most commonly through hospitalization and/or emergency services (n=26). The majority (75%) reported patient distress as a primary motivator for initiating help-seeking. Thematic analysis revealed recurring barriers such as stigma, inadequate provider knowledge of FEP symptoms, and limited awareness of available resources. Conclusion: While patients in the “EPIC First” subgroup had shorter DUPs compared to the national average (72 weeks), they still experienced aversive and stigmatizing pathways to care. Help-seeking episodes offer a more individualized lens to understand how structural and interpersonal dynamics shape access to early psychosis treatment. Community education and upstream referral strategies may support more positive pathways to care.