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.

Early intervention - Part 2

Positive Psychiatry and Mental Health

Meet the Instructors