YOUTH EARLY PSYCHOSIS:

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1 YOUTH EARLY PSYCHOSIS: Implementing a World First in a Rural Setting Jade Gooding, Executive Manager Mental Health Dr Tamoor Mirza, Clinical Director hyepp Rebecca Creek, Operations Manager headspace Darwin

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8 Did you know The rate of serious mental illness continues to increase, particularly in remote communities 1 3:1 Death by suicide for Aboriginal & Torres Strait Islanders is almost 3 times higher than non-indigenous in the NT 2 52% of people admitted into inpatient psychiatric facilities in the NT were Aboriginal 2 The rate of children in out-of-home care in the NT is double the national rate with almost 9/10 Aboriginal 2 NT has the highest rate of death by suicide for young people; 13.6 deaths per 100,000 compared to 2.2 deaths per 100,000 nationally 2 NT has one of the lowest per capita spends on Mental Health; however this is increasing 3

9 Priority Groups

10 Our Youth What are young people concerned about? 4

11 The history Prof Patrick McGorry

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14 Youth Early Psychosis YOUNG PEOPLE Aged years EARLY INTERVENTION Improving recovery and development HIGH RISK Developing psychotic symptoms CURRENTLY EXPERIENCING Psychotic symptoms

15 Youth Led Recovery Driven Family & Friends School & Work Holistic Approach to Health Culture, Gender & Sexuality

16 JOSH* 22 year old Aboriginal man from a small Community (Out skirts of rural Darwin, Northern Territory) Recent presentation to public mental health system with suicidal ideation and aggression No prior admission to the hospital for mental health concerns *Permission obtained from the elders of the community for the reproductions of the images.

17 First Contact Josh Assessment Mum Yolnju Matha Interpreter Aunty Psychiatric Review

18 Josh 2 Bedroom House Mum Aunty 2 Dogs 5 Cousins Cat

19 When we first met Minimal communication Irritable and at risk of further deterioration Impulsive (safety concerns) Difficulty sleeping Substance misuse and withdrawal At risk of losing housing

20 Symptoms Psychiatric Distressing auditory hallucinations Persecutory delusions Disorganised behaviour Sleep disturbances Other Seeing faces of deceased relatives Black Magic Being excluded from men s business Occasional cannabis & alcohol use

21 Stop the voices Mum & Aunty involved in care What did Josh want? Not to come into the hub Safe place to sleep

22 Home Based Care Ongoing care was completed in the home Medical Reviews Intensive Case Management Peer & Family Support Preferred by Josh & family Limited resources to commute Educate and empower Josh, his family and friends

23 Management Assessment Continuing Care Additional Therapeutic alliance patiently formed with Josh & family Medication commenced; regular reviews at home Family & Friends Support Coordinator with Family Mentor Person centred & family focussed care Physical check with Danila Dilba Peer Support Coordinator Age & culturally appropriate; visits with Aboriginal Family Mentor Recovery focussed intensive case management FRP Group - Fishing

24 Mobile Assessment and Care GP Danila Dilba Family & Friends Support Coordinator Josh Yolnju Matha Interpreter Aboriginal Family Mentor Peer Support Coordinator Mum Psychiatric Reviews Aunty Recovery Focussed Intervention Functional Recovery Intensive Case Management (housing)

25 Outcomes Distressing symptoms completely abated Reduction in use of alcohol and other drugs Home based care improved engagement Josh and his mother were assisted in securing separate accommodation Prevented admission to hospital Intervention at the early stage will lead to better long term outcomes

26 RORY* 16* year old transgender male; previously known as Amanda* Referred by the local Child & Adolescent Mental Health Team querying first episode psychosis No previous contact with mental health services

27 First Contact Assessment Rory Dad CAMHT handover Psychiatric Review

28 Sister Brother-in-Law Rory Dad Niece

29 When we first met History of self-harm and suicidal ideation Voices telling him to kill himself and harm others Struggling with his gender and sexuality Rory immediately warmed to the hub

30 Symptoms Psychiatric Command hallucinations Self-harming behaviour Suicidal ideation Other Gender & sexuality Maternal family history Bullying at school Sleep disturbances Functional Decline

31 Stop the voices Dad involved in care What did Rory want? A safe place to be himself More friends

32 Management Assessment Continuing Care Additional Therapeutic alliance quickly formed with Rory & his father Person centred & family focussed care Age appropriate Medication commenced; regular reviews out of hours Recovery focussed intensive case management Northside Clinic; doctors working together on possible medication interactions Peer Support Coordinator FRP Group Mural Bloom Prism Vocational Support; assistance to update CV and get part-time employment

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34 Psychiatric Reviews Northside Clinic Peer Support Coordinator Assessment Rory Recovery Focussed Intervention Intensive Case Management Youth Reference Group Vocational Support Dad Functional Recovery - Prism Functional Recovery Art Groups

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36 Outcomes Outcomes [insert LOVE photo] Complete remission of psychotic episode (late phase recovery) Improved social participation Training to become a Peer Support Worker Joined the Youth Reference Group Transitioning to male (some breakthrough psychotic symptoms due to medication change)

37 References 1. Northern Territory Mental Health Services Strategic Plan NT Government, Darwin. 2. Northern Territory Suicide Prevention Strategic Framework NT Government, Darwin. 3. Department of Health and Ageing (2013) National Mental Health Report 2013: tracking progress of mental health reform in Australia Commonwealth of Australia, Canberra. 4. Bullot A., Cave, L., Fildes, J., Hall, S. and Plummer, J. 2017, Mission Australia s 2017 Youth Survey Report, Mission Australia.

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