In today’s world, mental illness and distress are common and these account for a significant burden of disability within our community. At the same time, there is a growing interest in understanding and enhancing positive mental health and wellbeing; particularly from developments in the fields of positive psychology and mental health promotion. Positive Psychiatry is a new term (Jeste et al 2016) that describes a dual approach to mental health, where we build strengths, supports and healthy lifestyles as well as treating illness and distress. In this course, we will explore different aspects of good mental health as well as provide an overview of the major kinds of mental disorders, their causes, treatments and how to seek help and support. The course will feature a large number of Australian experts in psychiatry, psychology and mental health research, and we will also hear from “lived experience experts”, people who have lived with mental illness, and share their personal stories of recovery. We take an evidence-based approach to a range of strategies that anyone can use to enhance their own mental health and that of others, from exercise and relaxation techniques through to the role of love, relationships and 'good' types of work. We cover topics from creativity and yoga through to psychiatric medications and psychotherapies. This course is designed for anyone with an interest in psychiatry and mental health. It may be particularly helpful if you have struggled with illness, cared for a family member or friend, or work in a related field and would like to know more about how to assist people.
Early intervention - Part 2
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From the course by The University of Sydney
Positive Psychiatry and Mental Health
20 ratings
The University of Sydney
Positive Psychiatry and Mental Health
20 ratings
From the lesson
Module 5 - Paths to Recovery
In this module, we will detail some of the many paths to recovery. From early intervention through the philosophy of personal recovery, consumer support networks, creative arts as therapy as well as spiritual and religious practices.
Meet the Instructors
Sonia KumarPsychiatry Course Coordinator
Brain and Mind Centre, University of Sydney
There are many advantages in treating early. The first is you could say it's damage control because when mental illness is a for the first time usually an emerging adults. It's a very sensitive period of life because the young person is trying to establish their identity. They're trying to develop a vocational pathway with education and work. They're trying to separate from their family of origin and become independent humans. And you know it's a very challenging set of tasks. The brain is developing. There's a whole lot of factors there that a lot more risk taking behavior perhaps drugs and alcohol in the mix. So, it's a very very sensitive time. So, intervening early can prevent a lot of the secondary damage that can occur from delayed intervention which is really a social effect. If you become mentally ill and it's not picked up and treated effectively then you lose your friends, you lose your job, you drop out of the education system and might not even finish school and the family is put under major strain and you might also get addicted to drugs or alcohol in the process so picking it up early treating it effectively which we can do in the majority of cases is very very important. Well, the types of intervention that we see in a psychosis and other early intervention programs and youth mental health care are pretty needs based in the way. So, depending on the level of need and complexity of the problem, the interventions can be quite simple. It can be just a matter of a listening ear, support, reassurance, information and maybe some problem solving. And ranging right through to- to more intensive bio psychosocial care involving drug therapy more sophisticated psychological interventions and a more extensive social support and even outreach. So, it's a spectrum of care. We use a staging model to actually work out you know what intensity to offer. So if the person's in the early or mildest stages of a problem, obviously we respond, you know, we don't over treat people, we don't offer medications as the first line. But if the problem is not responding to those simpler interventions then we- we increase the dose and the expertise that's made available and the medication then might be a second or third stage offering for the person to choose. And we have a lot of evidenced-based treatments in psychiatry. And if they're delivered properly they can really transform the outcomes for most patients, not all patients we still have work to do for some people who- who don't respond to what we already have to offer. So that's a matter for research but in general we're very confident we can change the course for the majority of patients. Well if you think about early intervention it's best to turn the question around and say, when would early intervention not be a good idea? And I think there are two situations. The first one is where you've got no effective treatments. So there's no point, in a sense, of intervening early because it doesn't change the prognosis for the patient. You just intervene whenever you get the chance to. The other situation is where the treatments that you have to offer are likely to do more harm than good. And obviously every every powerful treatment especially drug therapies and more biological treatments but also psychological treatments they can have risks and harms associated with them. So we were very careful in medicine and health care not to overtreat. And the first principle is "do no harm" in medicine, goes right back to properties. And so we have to balance the- I suppose the ambition and the proactiveness of treatment with that- with that sort of caveat. But having said that in psychiatry, we do have effective treatments and they do have risks. So we've got to actually make the treatment proportional to the seriousness and stage of the problem. Early Intervention psychosis has been phenomenal and actually in the last 20 years in psychiatry. The treatment of psychotic illness is like schizophrenia were completely clouded by pessimism and therapeutic nihilism, certainly when I started psychiatry in the early- early to mid 80s. That was the message every single patient that was diagnosed with schizophrenia was told that the prognosis was very poor. They probably wouldn't be able to work that and they wouldn't have a normal life. Very hopeless message was given to the patients. But since then we've- we've found that if we do intervene early if we shorten the delays in treatment and if we deliver evidence-based care in a broad holistic way including psychosocial interventions as well as drug therapies and we make those consistently available that the outcomes are much better and we have 20 years of evidence and 10 international meetings on this subject to really strengthen the evidence-based in support of early intervention in psychosis. The outcomes are definitely better after two years or so. And the challenge then is maintaining those early benefits over the longer term and that requires investment in high quality mental health services to sustain those benefits which sadly in many locations is not- not available to the public. So there's a reform challenge here to make sure this evidence is actually realised in the lives of ordinary people. The other very exciting thing is that we've been able to go even earlier prior to the first psychotic episode and find people who are struggling and certainly impaired functionally and suffering but haven't quite made the threshold for diagnosis for schizophrenia or other psychotic illnesses. So this is called the prodromal or ultra high risk phase. And there are 11 clinical trials showing now that we can actually delay the onset of psychosis in this- in this at risk mental state as it presents. So I think the frontier has moved, you know, a long way forward. And in the next decade we'll really refine this and it will also extend the benefits of this approach to a whole range of diagnoses in young people. With the youth mental health focus. We've begun to extend the early intervention principle across the diagnostic spectrum into- into other disorders and these disorders are not discrete illnesses per se. There's a lot of overlap. And the way they emerge in the first place is usually through a mixture or constellation of different symptom patterns like depression, anxiety and maybe some substance use some personality issues and then you might get some warning signs of the more classical psychiatric illnesses like schizophrenia appearing. So this- this principle of early intervention that's been pioneered in psychotic disorders is now being applied in a more flexible way across the diagnostic spectrum. The evidence is still early compared to the large body of evidence including economic evidence in early intervention psychosis but it's starting to be assembled in mood disorders, in bipolar, depression, anxiety and eating disorders. And the journal early intervention psychiatry has been founded to really support and stimulate this sort of scientific research to create the evidenced based across the diagnostic spectrum. Early intervention and a fair deal for for people with mental illness, especially young people in the prime of life because 75 % of these illnesses appear before 25. This is not just a matter of scientific research and evidence it's a matter of health care reform. It's a matter of human rights. It's a matter of a fair deal for people with mental illness and that's 50 % of us at some point in our life. So it's a matter of self-interest as well as human rights and it's gonna take the whole community and our political leaders and the whole society really to get behind this reform. It's something that hasn't been possible until this stage of human history because the mentally ill have had a terrible legacy of suffering and neglect. But we're starting to see some light at the end of the tunnel here and it's been driven by science and evidence but it will only really change if the society as a whole demands that some action occurs.
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