Early psychosis intervention program is a community-based assessment program that is designed especially for outpatients that are experiencing first episodes of psychosis. It is however important to note here that there are a myriad of other conditions that might manifest themselves in similar manners as psychosis and correct and incomparable determination of psychotic cases is crucial. Immense research work has shown that early diagnosis and intervention on psychosis has had positive outlook in that the condition becomes relatively easy to contain unlike in late diagnosis where other complications might have arisen for example intense schizophrenia among others. It is for this reason that governments have embraced and embarked on refinancing mental healthcare institutions in an effort to try to contain the situations by improvement on assessment method, improvement on diagnostic methods as well as improved treatment approaches (Health Canada, 2002). Sudbury Mental Health and Addictions (SMHA) program is an integrated addiction and mental health care provider that has continued to serve deserving patients from all walks of life. They range from the rich to the poor, the young and the elderly, the educated and working class to the homeless, all of who seek mental health care intervention concerning various aspects of their lives.
Introduction and background
In as much as learning in class setting is important, equally important is also the fact that practical exposure in the real working environment gives unequalled challenge and opportunity that once maximized, can edify one’s future endeavors. It is for this reason that, as part of learning curriculum, the learner is expected to invest some time in a working environment and deal with real life cases. The learner has been investing two-half days every week in mental healthcare service providers to mingle with care providers and clients alike and learn as much as possible. In the healthcare setting, the learner gained exposure to clients that exhibited various disorders ranging from mood disorders, eating disorders, gambling and addiction, anxiety disorders, perinatal mental health issues as well as psychotic disorders to mention but a few. The learner at first was overwhelmed, not just by the number of clients that needed the services, but also by the efficiency that was flaunted by the healthcare professionals in the institution. The institution worked as a team with a myriad of approaches that were both efficient and focused on effective treatment and mainly entailed one or more therapeutic approaches.
At the facility, the learner was engaged mainly in the department that dealt with psychotic disorders where the main activities included program review via client satisfaction surveys that were conducted on six-month intervals. The survey is intended to help coordinators to know how successful, or otherwise, their approaches and mission are based on individual client assessment. It has been invigorating to see a client who initially walked in subtly, unkempt and non-communicative, gradually start changing the attitude, comes in a little tidy, and even starts to say hello and even communicate about the weather condition – a superfluous progress profile. At the facility, the learner was tasked to work in early intervention program as the learner looked forward to meeting these clients and perceive their progress.
Early Psychosis Intervention Issues
According to Stant, Castelein, Bruggeman, van Busschbach, van der Gaag, Knegtering and Wiersma (2011), it has been noted that “psychotic disorders with more emphasis on schizophrenia, have devastating, restrictive as well as negative influence of the social life” (p. 99) and (Tucker, Barker & Gregoire, 1998; Lowyck et al., 2004; Redlich et al., 2010). People and families that have individuals that depict aspects of psychotic disorders often experience segregation from other members of their extended families as well as the community around them. This makes it even harder for these families to seek help and many result in lockdown for their ailing family members to avert embarrassment episodes.
Stant et al. (2011) continues to note that, while the aforementioned is the case, the contrary should be happening since these individuals with “psychotic disorders should in essence be given peer support in an effort to share their individual experiences” (p. 99).
Van Oostrom, van Mechelen, Terluin, de Vet and Anema (2009) capture a rather captivating phenomenon where they note that, for workers who develop psychotic disorders while working and take “‘sick leaves’ often are encountered with difficulties and other return to work procedures” that are discriminative in nature (p. 212). In most cases, these workers get ‘sick-listed’ and get stigmatized at the workplace by their superiors and colleagues (van Oostrom et al., 2009).
Another important issue that is raised in the works of Callaly, Ackerly, Hyland, Dodd, O’Shea et al. (2010) involves “engagement of all stakeholders” in the decision-making table during and after the psychotic treatment process (p. 382). This, continues Callaly et al. (2010), has exacerbated the situation with aggravating “failures reported in reaching early expectations” (p. 382). This lack of involvement of all relevant stakeholders has in some cases, led to misdiagnosis between non-psychosis and early psychosis and thus missing the chance to arbitrate early treatment.
It is conversely noted that at mental health care centers, caseworkers also experience umbrage and isolation as compared to adult workers and this may lead to mistreatment, malpractice (Callaly et al., 2010) and unplanned readmission (Scott, 2010). It is further noted that most “psychotic disorders occur in adolescents in addition to early adult life” (Callaly et al., 2010, p. 383). When this occurs at such a tender age, there can be debilitating and lifelong disabilities, and thus the need for early interventions (McGorry, Killackey & Yung, 2007; Berk, Hallam, Lucas, Hasty, McNeil, Conus, Kader & McGorry, 2007; Callaly et al., 2010).
Treatment
In “psychiatric rehabilitation terms, the phrase recovery is defined as a process in which mentally disabled people rebuild connections to themselves, their environment, their society as well as their spiritual world as they continually deal with the preexisting stigma in their livelihood” (Davidson & Strauss, 1995; Redlich, Hadas-Lidor, Weiss & Amirav, 2010, p. 409). Conversely, treatment of psychotic disorder is multifaceted. According to Borras, Mohr, Gillieron, Brandt, Rieben, Leclere & Huguelet (2010), spirituality is an important aspect in many people, especially those suffering from mental disorder although there is a general claim that “clinicians often ‘neglect’ this imperative therapeutic” aspect in their treatment (p. 77). It is further noted that many clinicians are unaware of patients’ involvement in spiritual matters even though the gust of their feelings toward religion was welcomed by clinicians (Borras et al., 2010).
In the past, many psychiatrists believed that religious beliefs are just mental ululations and hallucinations that are irrational in every aspect (Borras et al., 2010). As a result, there has continued to exist a wide gap between psychiatry and religion since psychiatrists elucidate the psychotic occurrences in terms of biological and psychological causes that lead to mental illnesses and thus nullifying religious notions as more superfluous (Borras et al., 2010). Recent research has elucidated the issue noting that “spirituality has proved to be an imperative coping mechanism while dealing with socio—cultural and religious facets” of life and the illnesses like psychosis among other mental illnesses (Borras et al., 2010, p. 77, 78).
Treatment of the prevailing condition(s) has been found to reduce or even stop involvement by patients in risky behaviors (Milner, Barry, Blow & Welsh, 2010). It is further noted that psychotherapeutic approach that offer a wide array of treatment possibilities is a welcome trend that would involve among other things, psychotherapy, family psychoeducation as well as cognitive treatment (Milner et al., 2010). Milner et al. (2010) continues to note that proper and strategic application of these approaches would aid in “treatment entry while at the same time advocating for improved follow-up rates” (p. 150).
Another identifiable facet is the fact that hope plays a central role in the recovery of the mentally ill in addition to family attitude and role (Redlich et al., 2010). By definition, hope is perceived as the explicit positive cognitive state that is reliant on feeling of success that is present when planning a goal as well as the willpower to follow that goal to completion (Snyder et al., 1991; Redlich et al., 2010). Liberman, Kopelowitz and Ventura (2002; Redlich et al., 2010) note that imperative to the recovery process is the inherent role that the family plays. Darlington and Bland (2002; Redlich et al., 2010) continue to note that while hope is a major element, the family’s ability to cope and accept the condition is vital in the treatment process. “Hope and sharing help in appraisals, information support emotional” support (Dennis, 2003; Stant et al., 2011, p. 99) in addition to a major boost in the existing tincture of “hope” in the patient (Davidson et al., 2006; Stant et al., 2011, p. 99).
In some instances prescription of medications like “antipsychotic polypharmacy” (Goff & Freudenreich, 2004; Stahl, 2004; Constantine, Andel & Tandon, 2010, p. 528) may be inevitable in addition to antipsychotic monotherapy dosage.
Recommendations
There is an enormous amount of evidence that denote that early psychosis intervention, treatment as well as psychoeducation and support has potential to significantly reduce the impact that the illnesses have while abruptly reducing suicidal rates and incidences (Ricciardi, McAllister & Dazzan, 2008; Callaly et al., 2010). It is therefore recommended to the “government to invest more in early psychosis identification and treatment programs” that will enhance improved healthcare for those in need as well as an upbeat response approach (McGorry, Tanti, Stokes, Hickie, Carnell, Littlefield & Moran, 2007; Callaly et al., 2010, p. 383).
Secondly, it is proposed that regular and precise “revision of guidelines to be made for improvement” in the levels of admission of services (Callaly et al., 2010, p. 383). Constantine, Andel and Tandon (2010) continue to note that program revision to keep up with “recent as well as emerging contextual information is paramount while additionally considering the associated risks and benefits of each approach especially in prescription of antipsychotic monotherapy and polypharmacy” (p. 528).
For focus reduction efforts, there should be general guidelines on utility of low dosages of antipsychotics when being used as anxiolyitic or sedative elements (Constantine, Andel & Tandon, 2010).
It is also highly recommended that there should be strict monitoring of prescription patterns with provision of constant feedback to clinicians that are more inclined to prescribing antipsychotics such that the objectives of the services are laid bare (Constantine, Andel & Tandon, 2010). It is a fact that while these intervention cases are meant to stabilize the patient, it is not the intension of the care providers to completely exterminate the behavior and stigma that preexists in the individual’s life and/ or environment but rather a shift and reconsideration of the patient’s condition from a different vantage point (Constantine, Andel & Tandon, 2010).
It is also recommended that family psychoeducation be regularly and consistently conducted such that the family understands that the psychotic condition is not a premonition of doom but rather a life experience that is brought about by ideology and reverse perception. Cohesive family education on psychotic condition and the role that the family plays in the recovery process is important in heightening hope in the recovery process and the final outcome. When the family is hopeful, positive response is exhibited in the patient as well as faster recovery process.
While not all patients lie in the same religious background, it is equally important that the clinicians and other care providers to include, wherever and whenever necessary, spiritual guidance to the patients. As noted earlier, inclusion of spiritual aspects during the process can boost the morale to conquer the prevailing illness.
It is also advocated that a return to work formula be enhanced while involving senior management in the recovery process while conducting educative seminars to remove workplace stigmatization of recovering patients (van Oostrom et al., 2009).
Finally, since it is also clear that in some instances, a patient may be readmitted when the preexisting psychotic condition exacerbates or recurs, it is important to have an upbeat, multifaceted follow-up program. This may include among other things, “intense self-management training, nurse home visits, transition coaching especially to high-risk patients and telephone support to these patients” (Scott, 2010, p. 445).
Conclusion
In conclusion, it is noted that Sudbury Mental Health and Addictions (SMHA) program is an integrated addiction and mental health care provider that has continued to serve deserving patients from all walks of life. In the healthcare setting, the learner gained exposure to clients that exhibited various disorders ranging from mood disorders, eating disorders, gambling and addiction, anxiety disorders, perinatal mental health issues as well as psychotic disorders to mention but a few. It has been noted that psychotic disorders with more emphasis on schizophrenia, have devastating, restrictive as well as negative influence of the social life. People and families that have individuals that depict aspects of psychotic disorders often experience segregation from other members of their extended families as well as the community around them. This has exacerbated the situation with aggravating failures reported in reaching early expectations. It is further noted that most psychotic disorders occur in adolescents in addition to early adult life. Conversely, treatment of psychotic disorder is multifaceted. In the past, many psychiatrists believed that religious beliefs are just mental ululations and hallucinations that are irrational in every aspect.
Recent research has elucidated the issue noting that spirituality has proved to be an imperative coping mechanism while dealing with socio—cultural and religious facets of life and the illnesses like psychosis among other mental illnesses. It is further noted that psychotherapeutic approach that offer a wide array of treatment possibilities is a welcome trend that would involve among other things, psychotherapy, family psychoeducation as well as cognitive treatment. It is noted that imperative to the recovery process is the inherent role that the family plays.
While hope is a major element, the family’s ability to cope and accept the condition is vital in the treatment process. Hope and sharing help in appraisals, information support emotional support in addition to a major boost in the existing tincture of hope that the patient has. It is therefore recommended to the government to invest more in early psychosis identification and treatment programs that will enhance improved healthcare for those in need as well as an upbeat response approach. When the family is hopeful, positive response is exhibited in the patient as well as faster recovery process. It is also advocated that a return to work formula be enhanced while involving senior management in the recovery process while conducting educative seminars to remove workplace stigmatization of recovering patients. In so doing, the patient is likely to define new targets, implementation plans, and show a glimpse of satisfaction with improved expectation in the workplace.
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