Perhaps too many years ago to admit; I had the fortune to become involved in the life of a young man who was diagnosed with schizophrenia. I met him when he was first admitted, in his late teens; distressed, paranoid and suspicious and not exactly welcoming of inpatient treatment. I tried to offer a sense of hope for recovery and provided him with the space to talk about his reservations about medication and his frustration with what he felt was restrictive and coercive mental health care. Our relationship continued over the years when he experienced relapse and returned to the ward environment, usually detained under the mental health act, having stopped his anti-psychotic due to his perception that he was not unwell and his frustration about side effects of his medication. Latterly, I felt hopeful when he appeared to gain some insight into his difficulties and was adhering to his medication. But as a consequence, he was wrestling with the reality that whilst his siblings and peers were getting married, having children and settling into careers and new adventures, the reality for him was living on his own with an impoverished social network, unemployment, considerable weight gain with its resultant impact on his physical health, and a sense of hopelessness for the future.
It was with a heavy heart that a few months later, I found myself meeting his parents, for the first time, at his funeral. I will never forget the compassion and gratitude that his parents expressed to me, and to the service, for supporting their son over the years. As a parent myself, I often wonder why they were not angry and why they didn’t ask what we could have done better to prevent this tragic and untimely loss. Because, the reality is, we, and I, could have done better.
In the first year of experiencing psychosis, a person is 12 times more at risk of taking their own life than the general population. Suicide is the leading cause of premature death in individuals diagnosed with schizophrenia. But a third of people who present with psychosis recover and never have another episode. The trick, like most things in healthcare, is getting help early. The challenge is doing this with people who either don’t think there’s anything wrong, don’t ask for help, or their living circumstances and lifestyles don’t exactly match our service model.
For the last year and half, I have had the pleasure of working with colleagues locally with support from third sector agencies, people with lived experience and Health Improvement Scotland to pilot an Early Intervention Psychosis service in our rural health board. A first for Scotland, the naysayers challenge the need for this highly intensive, assertive approach to a relatively small group of service users when resources are increasingly rationalised and services overrun with demand. Psychosis usually occurs for the first time in late adolescence or early 20s and if life goes off track for you then, the impact is arguably much more significant than if you have already met some of life’s important developmental milestones. If we can get people treatment early and intensively, we can de-stigmatise psychosis and give hope for recovery and offer co-ordinated treatment including working alongside family and carers, vocational support and evidence based psychological therapies. We can prevent hospital admissions, get people back to work or studies, improve relationships with their loved ones, reduce carer stress, and crucially, keep people alive.
If you would like more information about Early Intervention Psychosis and our team, please get in touch and we’d be delighted to talk more about what we are doing, and what we hope to achieve in the future.
Katie Whyte is a Consultant Clinical Psychologist for NHS Dumfries and Galloway
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