1 - (IOP 2) Gatekeeping in Psychosis Care: A Reflexive Critical Content Analysis of Psychosis and Diagnosis

In the various CBT approaches to working with people with psychosis (e.g., CBT for Psychosis, Hagen et al., 2011; Kuipers et al., 2002; ACT for psychosis, Thomas et al., 2014), attention is given from the outset to flexibility in understanding what the person is experiencing, rather than designation of a specific answer. CBT formulations are then experientially-specific, and not beholden to a categorical diagnosis. This has enabled CBT to integrate well with the Recovery Movement and Peer Movement, each of which emphasize lived experience and person-affirming care. Nevertheless, the broader systems we work in remain tied to the DSM diagnostic model, leading to challenges separate from the science for how people get identified and are deemed eligible for innovative services such as coordinated specialty care (Heinssen et al., 2014; Murrie et al., 2020; Tanzer et al., 2021). Moreover, inequities remain in diagnosis and treatment for psychosis (Anglin, 2023; Loch et al., 2023; Moussa-Tooks et al., 2023; Oluwoye, 2018). To tackle these barriers, our qualitative research is focused on stepping back to examine diagnostic procedures as they are, with the aim of developing more person-centered, culturally flexible, and equitable methods of approaching psychosis identification and care. We used a reflexive approach to foundationally recognize the role of clinicians in the process of identification. From there, we used critical content analysis of the DSM-5-TR to reorganize how relevant experiences are identified and understood. I will describe the use of summative content analysis to: 1) Identify psychosis as a dimension of experience across the diagnostic spectrum; 2) Identify personally-centered mechanisms of how the DSM discriminates these experiences from other types of experience; and 3) Consider the effects of these mechanisms on the lived experience of seeking support for psychosis. We will consider the limitations of this research approach, particularly in the current context of diagnosis-based research methodology. Finally, I will discuss implications for the use of CBT and in coordinated specialty care programs.