Psychosis and a flat white

Maria Sampson and Kate Rapana

Outline • Our team • Early Intervention• Thoughts from a occupational and psychological framework • Starting out • How the group runs today• Case examples • Feedback from group members • Outcomes….

Our team • EI- TC (1 OT (1.0 ), 1 RN (0.7), 2 Psychologists (1.7), 1 Psychiatrist (0.5)

• Working out of urban Auckland

• Inclusion Criteria: FEP ( including substance induce and ARMS) , 18-35 years of age, DUP less than 2 years,

• Currently working with 52 young adults, 29 males and 23 females from a multi cultural back-ground

• We often stay involved for up to 4 years

• We offer individual work as well as a groups (including, sports/gym group, DBT informed-skills group, walking group, social group, relationship group) focused on psycho-social interventions.

Principles of an EI approach• Early detection and treatment • Reducing barriers to treatment• low threshold for assessment

• Focus on engagement • Intensive inputs enabled by lower case loads• Developmentally responsive and youth focussed service• Family interventions

• Optimistic recovery focus• Naturalistic supports

• Least restrictive practice and environments• Appropriate risk taking• Assertive follow up • Assertive Outreach (and In-reach) approach

Aims of Early Intervention‘Prevent, Reduce, Preserve’

• Prevent interference with psychological and social development • Reduce delay between the onset of symptoms and access

to treatment• Preserve relationships, prevent loss of social supports• Prevent unnecessary hospital admissions, reduce stress

and trauma• Reduce secondary mental health difficulties e.g.

depression, substance abuse, anxiety• Preserve identity and hope

Group work and Early Intervention

• Psychosis disrupts social networks, which in turn can worsen the outcome for individuals. Group work can meet a number of needs in early psychosis, including reducing social isolation, build self esteem and provide peer support. Interacting with people who share similar experiences and understand the impact of psychosis is highly valued by group participants (EPPIC – Australian clinical guidelines for early psychosis)

• Onset of psychosis often occurs during the crucial developmental period of adolescence or early adulthood. Without Intervention significant disruptions to the young adult’s psychosocial development becomes the norm (Patrick McGorry)

Social connections and Occupational Therapy• Occupational Therapists are a tool for enablement and engagement

in occupations. This requires us to look beyond an individual’s performance and functional capability to be truly client – centred (CMOP-E, 1997)

• Increased time spent in valuable and meaningful activities is likely to enhance the meaningfulness of the individual’s time use. It is also likely to encourage the development and achievement of personal goals, self efficacy and wellbeing (Scanlan et al.,2010)

More from the OT literature• The period following the first episode of psychosis is a time of high

risk for disengagement from activity and social participation. (Krupa, 2010)

• Article suggests six critical tasks for re-engagement in activity and social participation.

1. Making new plans.2. Developing a balance of activity and social routines.3. Participating despite disturbances in emotional connection to activities and

socialising. 4. Matching participation to the recovery of performance abilities.5. Managing self-care and social skills.6. Managing changed conditions and contexts for activity and social participation.

Some recent research findings• Establishing reciprocal relationships work as “buffer” against

distress experienced from auditory hallucinations and delusional beliefs (Gleeson et al., 2014)

• The main challenge of early intervention in first episode

psychosis is to prevent social exclusion, or at least seek to reduce it as soon as possible (Pachoud, 2013)

• Predictors of lower distress, ‘spiritual’ appraisals, greater perceived social support and understanding, and greater perceived controllability (Heriot-Maitland, McGuire& Peters, 2014)

How the group all began....• A young male and an Occupational Therapist having a

conversation about losing friendships, roles and routines, feeling isolated and disconnected. Lots of pressure from family to be doing more and he just wanted to go to a cafe for a coffee and feel “ a bit like I used to” Wanted to talk to other’s who may have experienced something similar to him....

• 2010 - Two young people from EIT and two Occupational Therapists having a flat white. Brainstormed what we wanted from the group. Ownership from the start on the participants.

• Funding provided for a hot drink for the first four weeks. Then expectation set if you attend you pay for your hot drink / food. (hardly ever have to pay for participants)

How it runs today• Weekly- always the same day and time• Group text sent in the morning, regarding location • Meet at Taylor centre or selected location. • Decision on where to go each week decided by group• Transport only from Taylor Centre, or meet at cafe by their own

organisation / time management• Mainly always the same facilitators • Everyone pays for own coffee/food • 8-12 attending regularly most weeks • NO set agenda

“Roll with the punches”• Don’t give up when limited numbers att• Be mindful of not setting the individual “goal post” to high. “Just

being there” can be the goal.• Do not be too restrictive on the topics of conversations. • Be quick to inform someone if topic is not for the group, but in a

way that is light hearted and keeps to the focus of the social aspect of the group.

• Be willing as the facilitator to offer some informal but personal information. Attempt to minimise hierarchal position.

• Foster cultural conversations , age related and societal topics and friendships

• Bring individuals celebrations and goals to the group’s attention.• Have a high threshold for exclusion• And of course humour goes a long way!!!!

Case presentation

• 22 year old male entered EI service in 2011…..

• 25 year old female entered EI service in 2012….

Some feedback from group members …• “Just getting out”, “ It’s about being in a social environment” (H, 20)

• “Having a social life”, “Going to new places” (Isa, 18)

More feedback…..

“ It’s more interesting than a Dr review” (Tom, 25)

“ When there is lots of people I get a warm feeling inside” ( Anita, 24)

…..

“Being with people my own age” (Greg, 19)

“Being with people- enjoy” (Sam, 22)

“It’s the people – being around people” (Hui, 26)

…..

“Positive outlook on life”

“ I look forward to Coffee group”

“ It’s good to be out talking to others”

…

“I was so anxious and nervous the first time I came to coffee group, but that’s gone now” (Jenna, 26 )

“It’s a chance to give back, by making people feel welcome when they are new”, “It provides me with a sense of warmth when the world feels cold” (Annie, 32, founding member)

Outcomes • NO pre and post measures

• Attendance

• Social connections – beyond group

• Work/study connections

• Transferable skills

• Feedback

Questions

References:

• Krupa T, Woodside H, and Pocock K (2010). Activity and participation in the period following a first episode of psychosis and implications for occupational therapy. British Journal of Occupational Therapy, 73(1):13-20.

• Brett C, Heriot-Maitland C, McGuire P, and Peters E (2014). Predictors of distress associated with psychotic-like anomalous experiences in clinical and non-clinical populations. British Journal of Clinical Psychology 53(2) 213-217.

• Lim MH, Gleeson JF, Jackson HJ, and Fernandez KC (2014). Social relationships and quality of life moderate distress associated with delusional ideations. Social Psychiatry & Epidemiology, 49(1):97-107.

• Scanlan J, Bundy AC, and Matthews LR (2010). Promoting wellbeing in young unemployed adults: The importance of identifying meaningful patterns of time use. Australian Occupational Therapy Journal.

• Pachoud B, (2013). Challenges of social reintegration after a first-episode psychosis. Encephale 39 (2) 105-109.