Early intervention
Early Intervention is a recent model in mental health, dating in Australia from the 1980’s, and as a major influence on mental health practice only from the 1990’s. The model builds on recent advances in our understanding of the epidemiology of psychotic illness, and in psychopharmacology, to focus on a preventative paradigm aimed particularly, but not exclusively, at young people experiencing their first episode/s of illness. The early intervention model also integrates health promotion concepts to allow health educators and practitioners to intervene in ‘prodromal’ conditions.
Does early intervention work in the same way for mental and physical illnesses
Learning Journal. At this point what do you understand by early intervention in relation to mental health? Does this compare to early intervention of diseases such as, cancer and lung disease? How? Or why not?
Early intervention in mental disorder
In topic 1.2, Concepts of Primary Care, you were introduced to some aspects of early intervention in mental illness. You also considered the influence of social attitudes, stigma, and culture on health behaviours. Bearing in mind what was learned in that topic, we will now focus on the concept and practice of early intervention in mental disorder.
Early intervention in the prodromal phase of a psychotic illness aims to reduce the psychosocial impact of an illness by instigating treatment quickly, reducing relapses and increasing the chance of complete recovery. While early intervention after the onset of psychosis means that treatment is commenced as soon as possible, thereby reducing the duration of the psychosis and limiting the prevalence of the disorder.
The concept of early intervention is relatively new and has had a positive outcome for many individuals, however delays in treatment do still exist for a number of reasons. Our aim is to explore the concept of early intervention and to examine possible reasons for delays in treatment.
Reading
Meadows G. and Singh B. (2001) Mental health in Australia. Collaborative Community Practice. Oxford University press Sydney. Pp 95 - 97
These two pages discuss the feasibility of early intervention and introduce a program that was commenced in Melbourne in the early 1980’s and later developed into a community-based program for assessing and supporting young people experiencing psychotic episodes.
Find out more by exploring these web sites
The Australian Network for Promotion, Prevention and Early Intervention for Mental Health (Auseinet)
Auseinet is a national project funded by the Australian Department of Health and Ageing under the Mental Health Strategy and the National Suicide Prevention Strategy. The first phase of the project began in 1997 to co-ordinate a national approach to early intervention for the mental health of children and young people. The project has now been expanded to include promotion, prevention and early intervention (PPEI), and suicide prevention, across the entire life span.This web site contains a wealth of information and useful links.
This monograph is associated with the National Action Plan for Promotion, Prevention and early Intervention for Mental Health (Action Plan 2000) by providing the theoretical and conceptual framework and background for the action plan. This is a large document that provides invaluable information. You should be able to find a hard copy in hospital libraries. The specific areas we would like you to read are listed below:
- Risk and protective factors on pages 13 –17. Take particular note of the tables 1 and 2.
- Chapter 6: Special population groups pages 83 – 93 in relation to Indigenous communities and migrants from non-English speaking countries.
- Chapter 8: Towards good practice in promotion, prevention and early intervention.
Reading
Sanbrook M. and Harris A. Origins of early intervention in first-episode psychosis Australasian Psychiatry 2003 11:2 p. 215
This article gives an excellent historical perspective for the delay in the introduction of early intervention. Factors and changes in attitudes that have led to the recognition of the benefits associated with early intervention and the subsequent policies for its implementation in Australia are discussed.
Reading
Newstead L., and Kelly M. Early intervention in psychosis: who wins, who loses, who pays the price? Journal of Psychiatric and Mental Health Nursing. 2003 10:1 p. 83 (E-reserve)
This is an interesting article that discusses the feasibility of providing early intervention programs for the person with an illness, mental health care providers and the government bodies who are responsible for funding.
Discussion board
Keith is a 17 year old who left school six months ago after completing year 11 at the local high school. Keith wanted to refer year 12 for a year because he found the previous years study very stressful and is not sure if he wants to continue with academic study. His parents are unsure about his decision but will respect his wishes and offer their support.
Keith’s behaviour has been deteriorating over the last two months. His parents took Keith to A&E after an argument during which he punched his hand through a window and sustained lacerations that required suturing. They informed you that he has been very isolated for the past three months, is moody, irritable and does not take care of his personal hygiene. Whenever they try to communicate with him, he becomes verbally abusive, which is out of character. His parents and his younger sister are beginning to become afraid of him. Upon further questioning they tell you that Keith has been staying away for the weekend and they often do not know where he is and what he is doing. They do know that he has been smoking cannabis and are suspicious that he may be taking other forms of drugs.
You interview Keith away from his parents. He is initially suspicious but soon relaxes and appears comfortable with the interview. He readily admits that he has been smoking cannabis. After further questioning he volunteers that he uses cannabis to reduce his thoughts that his family and friends are plotting against him. He cannot describe what the plot consists off and he says that at times he knows that these thoughts are not true however he cannot shake them off without the help of the cannabis. He denies hearing voices. He says that he hates feeling this way and would like to finish school and take up a career working with computers but at the moment he finds it to hard to interact with people.
After completing your MSE you form the opinion that Keith may be in the prodromal stage of an early psychotic illness. Using the information you have read on the principles of early intervention answer the following questions:
- What is your next step?
- What do you tell Keith about your assessment?
- What do you tell his parents about your assessment?
- Would you admit him to hospital? Why? Why not?
- Who else, if anyone needs to be involved in negotiating the care plan?
- What follow up will be required?
Share your answers with your fellow students on the discussion board.
Learning Journal
Review your last entry in your learning journal. Have you changed your opinion?