A Guide to Canadian Early Psychosis Inititative

1

Acknowledgements

Introduction

Early Psychosis Clinical Programs

Calgary, Alberta

Halifax, Nova Scotia

Hamilton, Ontario

Lévis, Quebec

London, Ontario

Montreal, Quebec

Ottawa, Ontario

Quebec City, Quebec

Saskatoon, Saskatchewan

Toronto, Ontario

Victoria, British Columbia

Other Early Psychosis Initiatives

British Columbia Early Psychosis Initiative

BC Regional Demonstration Projects:

Central Vancouver Island

North West

Okanagan Similkameen

South Fraser

Vancouver/Richmond

Canadian Mental Health Association National Project

Ontario Working Group

Glossary

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Over the past decade, recognition of theimportance of the early phases of psychosisto the subsequent course of illness and ofthe need to develop effective interventionshas grown at an ever-increasing rate inCanada and around the world. Now, manycentres are gaining the knowledge and experience that will lead to an improvedcapacity for the detection, treatment andsupport of those encountering psychosis for the first time. The fact that psychosismost often emerges during adolescence and young adulthood, severely disruptingthe course of these young lives, has been further impetus to the development of effective intervention strategies.

This Guide is an attempt to create a single,comprehensive source of informationregarding the many and varied early psychosis initiatives being pursued inCanada at this time*. The Guide is intendedto serve primarily as a reference tool formental health planners, practitioners, anddecision-makers interested in developing orexpanding early psychosis strategies andservices in their communities.

The initiatives included in the Guide represent both clinical programs and broader-based projects which may or maynot include clinical components. An effortwas made to become aware of and includeall Canadian programs and projects thatdemonstrate a concerted focus on early psychosis intervention, though it is possiblethat some were inadvertently missed. Aswell, given that new initiatives continue to emerge and existing initiatives continueto evolve, this Guide should be viewed as a snapshot in time. Data presented hereinwere collected during the latter part of 2000 and some of the specific information presented may already be outdated. Forexample, data pertaining to case numberswill tend to be in constant flux.

The information provided by clinical sites,generated by means of a questionnaire, ispresented in a relatively standard formatwith the exceptions of Ottawa andSaskatoon where services are at an earlier stage of development. The program descrip-tions include a listing of basic program data and clinical components, and someelaboration of adjunct program initiatives. The broader-based projects were invited to

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provide descriptions of their activities asappropriate. In compiling this Guide, balancing breadth with depth proved achallenge: in many instances, much morecould be written.

Basic elements of early psychosis interven-tion are either implicit or explicit in virtual-ly all of the initiatives. Elements include:ACCESS• Providing timely access to appropriate

clinical services ASSESSMENT• Offering comprehensive assessment

by trained cliniciansAPPROPRIATE TREATMENT• Establishing a therapeutic relationship• Providing a multidisciplinary team

approach to care• Providing care in the least restrictive

environment • Providing phase-specific, individualized

treatment that includes medication, psychoeducation and psychosocial interventions

• Providing services over time in order toconsolidate and sustain gains

FAMILY ENGAGEMENT• Engaging, educating and supporting

families through the treatment and recovery process

NORMALIZED RECOVERY CONTEXT• Supporting reintegration into school

and work activitiesAWARENESS AND EDUCATION• Reducing the duration of untreated

psychosis and supporting recoverythrough community outreach and education

• Providing opportunities for ongoing professional development for health care providers

Programs and projects are listed alphabeti-cally by location. Contact information isprovided for all initiatives. Taken together,the quantity and scope of the initiativesprofiled in this Guide attest to the highlevel of interest and activity in Canadatoday and also serve to illustrate the rangeof initiatives that are possible given a com-munity’s resources and state of readiness.*For an international review of early psychosis programs, seeEdwards, J., McGorry, P.D., & Pennell, K. (2000). Models ofearly intervention in psychosis: An analysis of serviceapproaches. In M. Birchwood, D. Fowler and C. Jackson (Eds.),Early Intervention in Psychosis: A Guide to Concepts, Evidence and Interventions. Chichester: Wiley & Sons Ltd.

INTRODUCTION

Early Psychosis Clinical Programs

3

FIRST YEAR OF OPERATION1997

TYPE OF SERVICEOutpatient

TYPE OF PROGRAMComprehensive population-based program

CATCHMENT930,000

PROGRAM ELIGIBILITY16 to 50 years of age; non-affective, firstepisode of psychosis; hospitalized for a firstepisode; no more than three months ofprior anti-psychotic drug therapy

PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENTApproximately one to two weeks

REFERRAL SOURCES In-patient units (33%); family physicians;community and outpatient psychiatryservices; community agencies; emergencyrooms; families; schools

AGE OF CLIENTS AT ADMISSION 67.8% under 25 years of age

OTHER CLIENT DATAGender - 66% male, 34% female

MAXIMUM STAY IN PROGRAM3 years

DIAGNOSIS AT ONE YEAR 100% schizophrenia spectrum disorders:40% schizophrenia; 39% schizophreniform;21% other psychotic disorders

AVERAGE NUMBER OF NEW CASES REFERRED FOR ASSESSMENT ANNUALLY120

AVERAGE NUMBER OF NEW CASES ADMITTED TO PROGRAM ANNUALLY80

ESTIMATED STANDING CASELOAD170

STAFFING (FTEs)

Nurse Case Managers 2.6Family Workers (MSW, MN) 1.5Group Therapist (MSW) 0.5Psychologist (PhD) 0.6Secretarial 0.7Psychiatrists 0.7

KEY CLINICAL COMPONENTS• Case Management• Psychiatric Management• Medication Management• Individual Family Work• Family Group• Individual cognitive-behavioural therapy

Brief cognitive therapy is aimed at three areas: adaptation to the onset of psychosis and its impact; treatment of secondarymorbidity; and treatment of persistent positive symptoms.

• Group ProgramsPsychosis Education GroupTeaching patients about the illnessRecovery Group12 sessions addressing issues in the early stages of recoveryMoving On Group12 session evening group addressing issues of later recovery for those who have returned to school or workSubstance Group10 session group to address issues relatedto substance use

ADDITIONAL INITIATIVESProfessional OutreachWhen the program started, staff visited the majority of mental health agencies, hospitals, universities and colleges inCalgary. Two years later, they sent lettersand an information brochure to these settings, and offered to return for anothervisit. Family physicians who admit patients to Foothills Hospital were also sent the

Early Psychosis Treatment & Prevention ProgramFoothills Hospital and University of Calgary

Dr. Jean Addington, Program ManagerDr. Donald Addington, Medical Director

4CALGARY, ALBERTA

Phone: (403) 670-4836Fax:(403) 670-4008Email:[email protected] site: www.ucalgary.ca/cdss/epp

Contact:Dr. J. Addington

Early Psychosis Treatmentand Prevention ProgramDepartment of PsychiatryFoothills Medical Centre1403, 29th Street, NWCalgary, Alberta T2N 2T9

5CALGARY, ALBERTA

brochure. Family physicians are a commonreferral source. Beginning in September 2000, in conjunctionwith the Canadian Mental Health Association,Alberta South Central Region, program staffhave been providing educational workshopsto teachers and guidance counsellors at thesecondary and post-secondary level, as well as to community-based health and social service agencies. These sessions are designedto raise awareness and provide training to promote the early identification of young people who might be experiencing symptomsof psychosis.

PRELIMINARY PROGRAM FINDINGSMean duration of untreated psychosis (DUP)is 69 weeks; median of 20 weeks. Data indicate that 72% of clients are in remissionat one year.

SITE RESEARCH INTERESTS INCLUDE:Outcome evaluation; neurocognitive functioning; MRI studies; prodromal research; DUP and pathways to care; social functioning and social cognition.



TYPE OF PROGRAMMulti-component, case coordination

CATCHMENT850,000 province-wide; resource to 3 neigbouring provinces

PROGRAM ELIGIBILITY12-54 years of age; non-affective first episode psychosis; less than five years of drug therapy for a non-affectivepsychotic disorder

PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENTOne to three weeks

REFERRAL SOURCESPsychiatrists, family physicians, schoolpsychologists/counsellors, mental healthprograms, families

AVERAGE AGE OF CLIENTS AT FIRST ASSESSMENT21.6 years

MAXIMUM STAY IN PROGRAMBased on individual need



ESTIMATED STANDING CASELOAD160 (includes active consultations)**Maximum caseload given current resources.

STAFFING (FTEs)*

Psychiatrist 0.5Family Physician 1.0Clinical Nurse Specialist 1.0Education Coordinator 1.0Occupational Therapist 1.0*Core funded positions. Additional staff funded from research grants/contracts.

KEY CLINICAL COMPONENTS• Medical/psychopharmacological

treatment• Patient and family psychoeducation• Access to 24 hr/day, 7 day/week

on-call nursing• Peer Group Sessions - Clients can

participate in peer support group sessions. Clients generally choose to participate for a period of approximately6 months. Group size is small and activities are client-driven.

• Occupational therapy assessment and referral to community support programs

ADDITIONAL INITIATIVESThe program carries out an extensive set of educational activities. The program hasdeveloped educational materials, includinga series of four ‘fact sheets’ for use inhealth facilities across the province, and avideo with discussion guide on psychosis.Educational sessions are provided onrequest to groups or individuals.

Family Information SessionsAn ongoing series of education sessionshas been designed for families and friendsof individuals experiencing first-episodepsychosis. The series consists of seven two-hour sessions delivered one eveningper week for seven consecutive weeks.Group size is generally from 12 to 16 people per series. Participants are encouraged to attend the full seven session series. Since the sessions began in January 1999, 100 family members have participated. Systematic evaluation of the sessions is carried out, including the use of standardized scales measuringfamilies’ experience of psychosis.

Family Support GroupIn January 2000, an Early Psychosis FamilySupport Group was established. This groupoffers an opportunity for family membersto continue with on-going education on

6HALIFAX, NOVA SCOTIA

Nova Scotia Early Psychosis ProgramThe Nova Scotia Hospital and Dalhousie University

Dr. Lili Kopala, Director

Contact:Dr. David Whitehorn

The Early Psychosis ProgramNova Scotia HospitalPO Box 1004, 300 Pleasant St.Dartmouth NS B2Y 3Z9

Phone: (902) 464-5998 Fax:(902) 464-6057Email:[email protected]

topics of interest to them, to share concerns and information, and to provide mutual support to one another.

Early Psychosis Mentorship ProgramThis program is designed to provide mental health clinicians, representing arange of disciplines, with access to the latest findings regarding assessment andtreatment of early psychosis. The programconsists of an initial introductory half-dayworkshop, followed by a series of special-ized workshops on a variety of topics tailored to the needs of participants.Participants have access to the clinic’sconsultative services for their own practice. Participants are encouraged tonetwork amongst themselves. Currently,a network exists of more than 200 mentalhealth workers from throughout NovaScotia and the Atlantic provinces whohave participated.

“Something is not quite right”: Early detection of serious mental illness, including psychosisThis half-day workshop program isdesigned for junior and senior high schoolstaff (teaching and non-teaching) and university student services personnel. Since initiation of the workshop inFebruary 1999, over 200 staff have participated from several school boardsand universities in Nova Scotia. Sessionsare case-based, highly interactive, multi-media presentations. Interested partici-pants are encouraged to attend the EarlyPsychosis Mentorship Program to obtainmore in-depth information on specificaspects of assessment and treatment offirst-episode psychosis.

Annual Psychosis ConferenceThe Fourth Annual Atlantic CanadaPsychosis Conference was held in October2000. This annual one day event providesa unique opportunity for mental healthpractitioners, family physicians, clients,families and interested community members to network and hear internation-ally known key-note speakers address the topic of early psychosis. The speakers also present interactive workshops duringthe conference.

7HALIFAX, NOVA SCOTIA

PRELIMINARY PROGRAM FINDINGSIn the first four years of operation, the program provided full assessments for 400clients with schizophrenia and schizophre-nia spectrum disorders. Early outcome databased on two years of program operationsuggest that 68% of clients had achievedfull remission of positive symptoms at 6months, with an additional 22% showingsignificant symptom reduction. Hospitalreadmission rates for all clients have beenless than 10% per year.

SITE RESEARCH INTERESTS INCLUDE:Population health outcomes; clinical trials;brain and cognition; family experience.



TYPE OF PROGRAM Care coordination and shared care

CATCHMENT160,000

PROGRAM ELIGIBILITY16-65 years of age; persons with psychosisat any phase are admitted; program is tailored to individual needs of clients ateach phase, including early psychosis

PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENTOne to two weeks

REFERRAL SOURCES OF FIRST-EPISODE (FEP) CLIENTS Family physicians (59%); in-patient (34%);emergency unit; schools, other

AGE OF FIRST-EPISODE CLIENTS AT ADMISSION TO PROGRAM

<18 yrs 6%18-25 47%25-30 17%30-35 15%>35 15%

OTHER CLIENT DATAGender - 57% male, 43% female; 33% offirst-episode clients using drugs/alcohol attime of admission

MAXIMUM STAY IN PROGRAMAs needed; active phase of treatment tendsto range from 16 to 30 months; clientsthen graduate to alumni status

DIAGNOSIS AT ONE YEAR 74.5% schizophrenia spectrum disorders;17% bipolar; 8.5% substance-induced psychosis

AVERAGE NUMBER OF NEW CASES REFERRED FOR ASSESSMENT ANNUALLY155 (includes consultations)

8HAMILTON, ONTARIO

Psychotic Disorders Clinic (PDC)Hamilton Health SciencesCorporation, McMaster Site

Dr. Suzanne Archie, Clinical DirectorHeather Hobbs, Team Coordinator

Psychotic Disorders ClinicOutpatient PsychiatryHamilton Health SciencesCorporation, McMaster Site1200 Main Street W.Hamilton, Ontario L8N 3Z5

Contact:Heather HobbsPhone:(905) 521-5018 Fax: (905) 521-2628Email Heather Hobbs at:[email protected]

AVERAGE NUMBER OF NEW CASES ADMITTED TO PROGRAM ANNUALLY25-30 FEP; (45-70 non FEP)

ESTIMATED STANDING CASELOAD100 active (38 FEP), 100 alumni (40 FEP)

STAFFING (FTEs)

Care coordinators (RNs) 1.8Psychiatrist 1.0Family Educator (RN) 0.6Occupational Therapist 0.4Psychometrist 0.2

KEY CLINICAL COMPONENTS• Comprehensive assessment• Individual psychoeducation and support• Family psychoeducation and support

(Family Educator role - see below)• Negotiated treatment agreements• Low-dose, slow increment antipsychotic

medications• Support for reintegration (rehabilitation)• Shared care with family practitioners

THE THERAPEUTIC PARTNERSHIP (TP) The Therapeutic Partnership (TP) is anevolving model developed by the Clinic toaddress the complex needs of the client,family and treatment team members. Ithas been in use since the early 90s. It is a model guided by theories of coping andadaptation, and premised on shared powerin the decision-making process in order to empower all partners – client, familyand team members – equally. It is guidedby a set of beliefs and values that includesrespect, dignity, hope, empowerment, consensual decision making and the well-being of all.

All partners share a series of rights andresponsibilities. The partnership is builtthrough the pursuit of five complementarytasks: Alliance, Accompaniment,Agreement, Action, and Accessibility (the “Five As”).

9HAMILTON, ONTARIO

Therapeutic Partnership goals are to:• Provide an environment that will

support recovery from psychotic illness • Empower clients and members of

their natural social network • Prevent estrangement and social

marginalization.

The TP model includes three phases of intervention: assessment, treatment/rehabilitation, and an “alumni program”.

FAMILY EDUCATORThe Psychotic Disorders Clinic (PDC) hasdeveloped and evolved a staff positioncalled “Family Educator” to specificallyprovide professional support to familieswhose relative has experienced a psychoticepisode. The Family Educator providesinstrumental and emotional support, education and advocacy for family members. This family-centered model of service provision overtly recognizes theneeds of all family members and offersequal access to team resources during allclinical phases of assessment, treatment,rehabilitation and alumni follow-up.

ALUMNI PROGRAMThe Alumni Program is viewed as a novelapproach to continuing care. In operationsince 1993, it has served 100 clients andtheir families. It is premised on a chronicillness model, similar to approachesapplied to chronic conditions such as diabetes, arthritis or asthma. Clients maychoose to transfer to alumnus status astheir active phase of treatment is concluded. The program is a form ofshared care that involves a partnershipamong the client, family physician, PDCand other health professionals. Clientsarrange a schedule of visits with their family physician and similarly negotiate a schedule for checking in with PDC atthree, six or twelve month intervals.During these check-ins, the goals and treatment plans for the next alumni interval are negotiated. PDC remains aneasily accessed resource to both client andfamily physician, and clients may return to active client status if necessary.

Alumni Program goals are to:• Provide continuity of care• Empower clients toward the goal of

health maintenance

• Share care effectively with family doctors• Reduce client dependency on the “system”• Provide support to GPs• Support the health of a large number

of clients.

The Alumni Program rests on values ofhealth, recovery, hope, trust and empower-ment, and partnership. A trusting relation-ship among clinicians, client and familyis requisite.

DATA TRACKING Quality of life; client satisfaction; relapserate; rehospitalization; ER use; suicide (andattempts); substance use

SITE RESEARCH INTERESTS INCLUDE:Program evaluation; alumni study; familyand client satisfaction.



TYPE OF PROGRAMCase management, multidisciplinary team

CATCHMENT210,000

PROGRAM ELIGIBILITYAge 16 years and up

PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT4 to 6 weeks

REFERRAL SOURCES Referrals generally come from outpatientclinic psychiatrists at Hôtel-Dieu. Initialassessments are performed at the clinic,resulting in 100% intake of these referralsto the First Episode Program. GPs tend tobe the original source of referral to the outpatient clinic.

MAXIMUM STAY IN PROGRAMBased on individual need, but generallyclients are in the program for one year plus followup at regular intervals.



STAFFING RESOURCES INCLUDE:Psychiatrists, social worker, occupationaltherapist, psychologist, nurses, educatorsand a work integration specialist.

KEY CLINICAL COMPONENTS• Comprehensive Assessment• Building a therapeutic relationship• Medical and pharmacological

management• Individual psychoeducation for clients

and parents• Multi-family group education

10LÉVIS, QUEBEC

Le programme spécifique d’intervention Premier-Épisode*Hôtel-Dieu de Lévisand Laval University

Dr. Luc Nicole,Program Coordinator

Département de Psychiatrie Hôtel-Dieu de Lévis 143, rue Wolfe Lévis, Québec G6V 3Z1

*First-Episode SpecificIntervention Program

Contact:Dr. Luc NicolePhone:(418) 835-7155Fax:(418) 835-7199

• Individual cognitive-behavioural therapy• Group interventions - two 1.5 hour sessions weekly for an 8 month periodwith 4 to 7 patients per group. Groupsfocus on developing cognitive, emotionaland social competence required for inte-gration into school and/or work settings.Group meetings are co-facilitated by anoccupational therapist and an educator.

ADDITIONAL INITIATIVES• Ongoing professional development

for treatment team members through bi-weekly seminars

• Awareness raising sessions are providedto mental health teams from CLSCs(community health centres)

• Family physicians are educated in a series of training conferences about the early signs of schizophrenia.

SITE RESEARCH INTERESTS INCLUDE:Study of the evolution of the illness, tracking individuals for a 36 month period.

DIAGNOSIS AT ONE YEAR87% schizophrenia spectrum disorders; 6%substance-induced psychosis; 4% psychosisNOS; 2% bipolar; 2% delusional disorder

AVERAGE NUMBER OF NEW CASES REFERRED FOR ASSESSMENT ANNUALLY85 (80-90)

AVERAGE NUMBER OF NEW CASES ADMITTED TO PROGRAM ANNUALLY55 (50-60)

ESTIMATED STANDING CASELOAD105**maximum treatment caseload given current resources.

STAFFING (FTEs)*

Clinical/Education Leader 1.0Nurse Case Managers 5.0Social Work Case Manager 1.0Social Worker (MSW) 0.6Clinical Psychologist (PhD) 1.0Secretarial 1.5Psychiatrists 2.5 (plus Director)*Outpatient services only. Inpatient staffing and research personnel additional.

KEY CLINICAL COMPONENTS• Engagement and formation of

therapeutic alliance• Case management• Medical/pharmacological management• Patient and family psychoeducation• Individual cognitive-behavioural therapy• Group programs

Recovery through Activity and Participation Group (RAP)The RAP group assists young clients withthe transition back into their regularactivities by focusing on the life andsocial skills that will help them in thecommunity. The group is offered as atwo hour session, twice weekly forthree months.

Youth, Education and Support Group (YES)A series of 8 weekly two hour sessions areoffered to young clients to provide anopportunity to discuss the issues they

Prevention and EarlyIntervention Program for Psychoses (PEPP)London Health SciencesCentre and University of Western Ontario

Dr. Ashok Malla, Director

Contact:Dr. Ashok Malla

London Health Sciences Centre392 South Street London, Ontario N6A 4G5

11LONDON, ONTARIO

Phone:(519) 667-6773 Fax: (519) 667-6537Email:[email protected] site: www.pepp.ca


TYPE OF SERVICEPredominantly outpatient, plus dedicatedbeds within a 16 bed inpatient PsychosisUnit in a general hospital (London HealthSciences Centre).

TYPE OF PROGRAMAssertive case management

CATCHMENT390,000

PROGRAM ELIGIBILITY16 - 50 years of age; non-affective, first-episode psychosis; no more than 1 monthof prior antipsychotic drug therapy

PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT48 hours maximum to initial screeningassessment; telephone contact immediate;location of initial screening assessmentvaries as necessary (clinic, home)

REFERRAL SOURCES Inpatient (41%); community physicians(38%); family/self and schools (21%)

AGE OF CLIENTS AT ADMISSION

<18 yrs 19% 18-25 47%25-30 13%30-35 10%>35 11%

OTHER CLIENT DATAGender - 75% male, 25% female; 71% ofclients using some drugs (mostly cannabis)or alcohol at time of admission

MAXIMUM STAY IN PROGRAMCore program: 2 years. However, after 2years in the program, if a significant degree of recovery has not been achieved,clients can participate in one additionalyear of intensive case management. After 2 to 3 years, patients continue in medicalmanagement with their respective psychiatrists in the Program.

12LONDON, ONTARIO

confront related to psychosis (e.g., stigma,peer group pressures, drugs/alcohol, etc.)Each week a different theme is discussed.

Cognitively Oriented Skills Training (COST)COST is a 10 week program for clients whoare preparing to return to school or work.The purpose is to improve skills to compen-sate for cognitive deficits.

Multiple Family Group InterventionsBeginning in January 2001, families whohave been with PEPP for two years or morewill be invited to participate in regularlyscheduled multiple family group sessions.

ADDITIONAL INITIATIVES

School-Based Awareness and Case Detection ProgramIn 1997, the Program Director and staff contacted one of two local school boards,requesting permission to conduct a pilotcase detection project in its high schools.Five schools participated. School officials,guidance counsellors and teachers firstattended an information session focusingon early psychosis detection and the importance of reducing the duration ofuntreated psychosis (DUP). One of the program staff then attended each school for 2 hours weekly as part of the school’sregular guidance meetings. This processfacilitated a greater understanding of earlypsychosis and improved the detection skills among participating school staff, and strengthened the relationship betweenPEPP and the community.

Assertive Community Case Detection ProgramIn January 2000 the Program launched anassertive case detection program in the com-munity with a massive poster campaign, use of local media - including 30-second television spots, public forums, direct con-tact with all educational institutions, healthcare agencies, and community physicians.Extensive case detection materials havebeen prepared with assistance from familiesand clients. Information pamphlets havebeen delivered to most health and social service agencies in London, and made available to the public.

Family Psychoeducation Workshop and MaterialsA one day, 8 hour workshop is conductedonce every three months in an effort toinform family members and other interestedindividuals about psychosis, interventions

and routes to recovery. Recently, a newvideo series with an accompanying writtenguide has been developed by PEPP to augment the family education process.These materials are best used initially bystaff with families, and later by families on their own or in the context of a support group.

Family Support GroupInitiated and maintained by PEPP familymembers, this group provides a great sourceof mutual support and encouragement. Itcontinues to prove invaluable in terms ofraising community awareness and advocat-ing on behalf of the needs of their lovedones. It is also serving as a model to first-episode families in other regions of thecountry. For additional information, contact Brenda Wentzell([email protected]).

PRELIMINARY PROGRAM FINDINGSDUP Data and Remission Rates Mean DUP has decreased from 20 months(1997-98) to 15 months; median DUP from 7 months (1997) to 3 months (1999).Significant difference in one year remissionrate related to DUP observed: of those entering the program with less than sixmonths DUP, 82% were in remission at one year compared to 58% of those with a DUP greater than six months (p< .03).

Hospitalization Hospitalization rates for initial treatment:53%; 47% are treated as outpatients.Readmission rates at one year: 15-20%.

SITE RESEARCH INTERESTS INCLUDE:Prodromal indicators; development of new psychosocial treatment strategies; longitudinal/epidemiological outcome studies; relationship between DUP with cognition, quality of life, symptom profilesand premorbid adjustment; effect of phase-specific treatment interventions.

STAFFING (FTEs)*

Psychiatrist 0.2 Resident 0.2 Nurse 0.1 Occupational Therapist 0.4 Community Worker 1.0*outpatient staffing only.

As required:Psychological testingPsychologist/therapySocial WorkerEducator/teacherAlso, there is a nurse and occupationaltherapist in a local CLSC who see some of the patients.

KEY CLINICAL COMPONENTS• Establishing a therapeutic alliance• Medical and pharmacological management• Family education and support• Individual cognitive therapy• Individual supportive therapy• Occupational therapy groups• Community-based networks of support

ADDITIONAL INITIATIVESCommunity Linkages: Supporting DetectionTo enhance the chances of early detection,EPIC has forged various links with commu-nity-based settings. It is working closelywith the Quebec chapter of the Alliance for the Mentally Ill (AMI Quebec) whohave an educator who goes into schools togive information about mental illness. EPICstaff have been directly involved in infor-mation sessions with teachers, along whoAMI-Q as well. They have also developedlinks with school counsellors and some pri-mary care settings such as AssociationQuebecoise de la Schizophrenie, familymedicine practices, local communityhealth centers (CLSCs), crisis units andemergency rooms. They organize meetingsin schools with teachers and administra-tors, and have developed links with CLSCsas well as possible to facilitate referral.

Early Psychosis InterventionClinic (EPIC)McGill University HealthCenter, Royal VictoriaHospital, Allan Memorial Institute

Dr. Marc Laporta, Director

Contact:Dr. Marc Laporta

McGill University Health Center Royal Victoria Hospital,Allan Memorial Institute1025 Pine Avenue WestMontreal, Quebec H3A 1A1

13MONTREAL, QUEBEC

Phone: (514) 842-1231 x4393Fax: (514) 843-1644Email:[email protected]



CATCHMENTApproximately 250,000

PROGRAM ELIGIBILITY17 to 30 years of age; recent onset of pre-psychotic or psychotic disorganizationof less than one year duration

PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENTTwo to three weeks; phone consultationsare available to the referring source in theinterim.

REFERRAL SOURCESCrisis Unit; regular out-patient department;Emergency Room; in-patient units and dayhospitals; CLSCs (community health cen-tres); schools; GPs


<18 7%18-25 75%>25 18%

OTHER CLIENT DATAGender - 66% male, 33% female

MAXIMUM STAY IN PROGRAMNo predetermined maximum; stays haveranged from 2 months to 4 years.

APPROXIMATE NUMBER OF NEW CASES REFERRED FORASSESSMENT ANNUALLY25

APPROXIMATE NUMBER OF NEW CASES ADMITTED TO PROGRAM ANNUALLY20


14MONTREAL, QUEBEC

Community Linkages: Supporting RecoveryIn order to counter the avoidance of high-stigma psychiatric services, EPIC hastried to create intermediate “holding environments” with agencies with whichthey form an extended team extendingbeyond institutional bounds. These includeprominently the CLSCs, where patients canbe seen while warming to the idea of treatment, and community support groups,where a normalizing stance is upheld - themain alliance here is with a group called“Projet-ARC” (Agency for Reintegration inthe Community). Community-based reha-bilitation work includes behavioural work,as well as preparation for employment andacademic support and short-term tutoring.

SITE RESEARCH INTERESTS INCLUDE:Developing early markers for relapse;understanding the fit between help-seekingbehaviour and interventions offered.

Ottawa First EpisodePsychosis Program(Programme de la premièreintervention de la crise depsychose, Ottawa)The Ottawa Hospital andUniversity of OttawaDr. Paul Roy, Director

Contact:Ms. Claudia HampelOttawa Hospital501 Smyth StreetOttawa, Ontario K1H 8L6

15OTTAWA, ONTARIO

Phone:(613) 737-8899ext. 73062Fax:(613) 737-8085

The Ottawa First Episode PsychosisProgram/Programme de la première intervention de la crise de psychose(Ottawa) is currently in the early stages of implementation. The Program is activelysupported by the Dean of Medicine and the Chair of Psychiatry at the University of Ottawa, as well as The Ottawa Hospitaland the Ottawa and Cornwall chapters of the Ontario Schizophrenia Society.The Program is included in the presentFunctional Plan of the Ottawa Hospital –General Division. A formal application for expansion funding has been presentedto the Mental Health Implementation Task force in the Champlain Region. This application will also be presented to the Deputy Minister of Health forOntario in January, 2001.

The Program will serve the population ofEastern Ontario and the National CapitalRegion, a catchment representing approxi-mately 1.5 million persons. All services will be offered in both official languages.Criteria for program eligibility include: age 17 years and up; first-episode psychosiswith a maximum of 6 months prior treat-ment with anti-psychotic medication. The Ottawa Program will represent anassertive case management approach tocare. It will consist of a multi-disciplinarystaff, including an attending psychiatrist,case managers with nursing and socialwork training, an occupational therapist, a psychologist, a data coordinator, a fulltime secretary, as well as a consulting pharmacist.

The Clinic will be located and providemost of its services in a community clinicsetting. A maximum of six dedicated first-episode inpatient beds on the psychiatricunit at the Ottawa Hospital – General Site,

will be available to support hospital admissions for the Program as required.Patients will only be admitted to hospital if their illness is sufficiently severe to render them a risk to themselves or others. The attending psychiatrist from the Program will supervise inpatient care. A mobile team will be included in the program to perform assessments in thecommunity and to support patients intheir homes when necessary.

Referral sources will include emergencyroom physicians, community psychiatristsand general practitioners, college and high school staff and the general public.Referrals will be made directly throughProgram staff via a 24 hour – 7 days per week “hotline” which will be advertised to referral sources throughoutEastern Ontario.

Multidisciplinary staff in the communitysetting will provide care for patients andtheir families on an individual and groupbasis. Care will be provided for up to 3years and will be tailored to the eachpatient’s specific phase of illness, includingthe acute early recovery and late recoveryor stable phases of illness. The key clinicalgoals will be to minimize duration ofuntreated psychosis, optimize recoveryand reintegration for patients, and to avoid hospitalization as much as possible.The Program will also serve as an educational and consultative resource for families and physicians throughout the entire catchment area.

Polyclinique Sainte Anne65, Ste. Anne, 2nd FloorQuébec City, Québec G1R 3X5

*Clinical Services for First-Stage Psychosis Patients,their families and NetworkProfessionals

16QUEBEC CITY, QUEBEC

Contacts:Marie-France Demers, PharmacistXavier DeVriendt, PsychiatristPhone: (418) 691-0777Fax: (418) 691-2667Email: [email protected]


TYPE OF SERVICEOutpatient with access to beds at psychiatric hospital

CATCHMENTOver 600,000

PROGRAM ELIGIBILITY Over 18 years of age; first-episode psychosis; schizophrenia focus

PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENTGenerally one to two weeks

REFERRAL SOURCES Mostly GPs and inpatient unit of generalhospital; will take family/self referrals

OTHER CLIENT CHARACTERISTICSMany using drugs or alcohol at time of admission

MAXIMUM STAY IN PROGRAMTwo years

NUMBER OF NEW CASES ADMITTED TO PROGRAM500 admissions over a 40 month period

STAFFING RESOURCESINCLUDE:Psychiatrists, nurses, social workers, occupational therapist, clinical pharmacists, neuropsychologist.

KEY CLINICAL COMPONENTS• Multidisciplinary approach including

medical, pharmacological, psychosocial, psychoeducational and family interventions

• Psychoeducational groups• Family education and support -

including home visits and groups• Client groups address: understanding the

illness, anxiety management, substance abuse, social skills, time management, self-esteem, problem-solving, managing a budget and other issues related to integration.

ADDITIONAL INITIATIVES• Presentations and clinical training

with GPs• Plans to extend gatekeeper training

with school personnel, community pharmacists, community health centre staff

SITE RESEARCH INTERESTS INCLUDE: Psychopharmacology; medication trials; psychosocial studies; genetic research.

Services cliniques pour les personnes en début d’évolutiond’une psychose, les proches et les intervenants du réseau*Polyclinique Sainte AnneCentre hospitalier Robert-Giffard and Centre de recherché Université Laval Robert Giffard

Dr. Roch-Hugo Bouchard, Director

Early Intervention Programin Psychosis andSchizophreniaSaskatchewan DistrictHealth (SDH) andUniversity of SaskatchewanDr. D. KeeganDr. S. Shrikhande

Contact:Rose Oxby or Dale Ziolkowski,Community Mental Health Nurses

Adult Community Mental Health Services4th floor, 715 Queen StreetSaskatoon, SK S7K 4X4

17SASKATOON, SASKATCHEWAN

Phone:(306) 655-8858 (Rose) (306) 655-8859 (Dale)Fax: (306) 655-8875

The Early Intervention Program (EIP) is anoutpatient service which began in May1999, functioning within the context ofSDH, Mental Health Rehabilitation andAdult Community Services, theDepartment of Psychiatry of the Districtand University of Saskatchewan. The catch-ment of Saskatoon and surrounding regionrepresents a population of approximately225,000. All persons within the catchmentwho may be experiencing a first episode ofnon-affective psychosis, with symptoms ofup to two years duration, are to be referredto the EIP for rapid evaluation, treatmentand rehabilitation. The maximum stay inthe program is two years.

Referrals to the program must be madethrough family physicians or psychiatrists.Referrals are first contacted by telephoneand the attempt is made to see the personwithin 72 hours. The program utilizes anassertive case management approach withintensive psychoeducation for clients andfamilies. Staff consists of two communitymental health nurses and two resource psychiatrists. In its first seven months ofoperation, 41 clients were participating inthe program. The age range of clients hasbeen 15 to 42 years.

Key clinical components include medicaland pharmacological management, psychoeducation (individual and group) for both clients and family members, andskill building (coping, stress management,problem solving).

First Episode PsychosisProgramCentre for Addiction and Mental Health, Clarke Division

Dr. Robert Zipursky,Director

Contact:April Collins, Manager

Centre for Addictionand Mental HealthClarke Institute250 College StreetToronto, Ontario M5T 1R8

18TORONTO, ONTARIO

Phone:(416) 535-8501 x4828email: [email protected]


TYPE OF SERVICEOutpatient plus dedicated first-episode 12 bed inpatient unit

TYPE OF PROGRAMMultidisciplinary, time-limited case management

CATCHMENTNo restrictions, Toronto area, population 4 million

PROGRAM ELIGIBILITY18 - 45 years of age; first episode of a primary psychotic illness; no more thanthree months prior anti-psychotic drugtherapy; not appropriate for those with a mood disorder, a general medical condition considered to be the cause oftheir psychosis, or developmental delays

PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENTMaximum wait of 2 weeks for outpatientevaluation; triage system in place to deal with more urgent cases within onework day. Clients are assessed in the clinic setting.

REFERRAL SOURCESFamily physicians (30%); in-patient (25%);emergency department (25%); communitypsychiatrists (10-15%); schools and community services (10-15%)

AGE OF FIRST EPISODE CLIENTS AT ADMISSION

< 16 5%17-24 51%25-29 15%30-34 13%35 + 16%

OTHERCLIENT CHARACTERISTICSGender – 68% male, 32% female

MAXIMUM STAY IN PROGRAMTwo years




STAFFING (FTEs)*

Psychiatrists 2.0 Nurse 2.0Occupational Therapist 1.3Social Worker 1.0*outpatient staffing only

KEY CLINICAL COMPONENTS• Individualized, family-inclusive,

multidisciplinary assessment• Time limited (2 years) multidisciplinary

care focused on optimizing outcome• Menu of services provided which

include individual and group approaches.These are tailored to the needs of the person and his/her family.

ADDITIONAL INITIATIVESCommunity Activities/OutreachActivities include ongoing community outreach at different hospitals; an annualconference on first-episode psychosis thatis well-attended by a broad cross-section of providers and educators (approx 200attendees); and extensive promotion of the program across the province.

SITE RESEARCH INTERESTS INCLUDE:The First Episode Psychosis Program has a strong commitment to clinical researchinto the mechanisms underlying the devel-opment of schizophrenia and its treatment.Neuroimaging approaches have been animportant component of this research program and have been utilized to under-stand mechanisms of treatment responseand to characterize the brain structure andfunction in schizophrenia. Understandingthe role of cognitive dysfunction in schizo-phrenia and characterizing the long-termoutcome of schizophrenia are also major priorities for this program.

Schizophrenia Service/Early PsychosisInterventionVictoria Mental Health Centre

Dr. Richard Williams,Director

Contact:David Butler,Program Coordinator

Victoria Mental Health Centre2328 Trent StreetVictoria, British Columbia V8R 4Z3

19VICTORIA, BC

Phone:(250) 952-4410Fax: (250) 952-4241Email: [email protected]

FIRST YEAR OF OPERATION1995 with increasing focus and specialization of services for first- episode cases since 1998

TYPE OF SERVICEOutpatient, inpatient and residential

TYPE OF PROGRAMCase management, including medical and psychosocial management

CATCHMENT320,000

PROGRAM ELIGIBILITYNo age restrictions

PERIOD OF TIME BETWEEN REFERRAL AND ASSESSMENT2 weeks

REFERRAL SOURCESMost common source is GPs.


< 18 yrs 15%18-25 45%25-30 30%30-35 10%

MAXIMUM STAY IN PROGRAMNot specified


ESTIMATED STANDING CASELOADApproximately 180 first-episode cases

STAFFING RESOURCESINCLUDE:A coordinator, psychiatrists, case managersand access to psychologists, recreationaltherapy and occupational therapy.

KEY CLINICAL COMPONENTS• Assessment• Case management• Medical and pharmacological

management• Psychoeducation for client and family• Group and individualized programs• Residential treatment (specialized for

first-episode)

ADDITIONAL INITIATIVES• Community liaison/education• Family support group • Sibling support group• Educational retreats• Member of the British Columbia

Early Psychosis Initiative

SITE RESEARCH INTERESTS INCLUDE:National Outcomes study; medication trials

Other Early Psychosis Initiatives

20

Project Manager:Laura Hanson, Ph.D. Phone:(604) 263-3502Email:[email protected]

21BRITISH COLUMBIA EPI

BACKGROUNDThe Ministry of Health’s (MOH) MentalHealth Plan, announced in January 1998,established a basis for examining mentalhealth issues involving early identificationand intervention for youth and youngadults with mental illness. Historically,early identification and intervention services for youth and young adults with aserious risk for a mental illness have beenidentified by the Ministry for Children andFamilies (MCF), particularly as they applyto the development of youth transitionservices. These and other joint MCF/MOHissues were identified in 1999/00 as priori-ties to be addressed in the Child and YouthMental Health Plan to be completed in thefall of 2000.

In 1999/00, consistent with the provisionsof the Mental Health Plan, the MOH undertook an initiative with one-timefunding of $1.15 million to further thegoal of developing prevention and earlyintervention services for young persons(ages 13 to 30) at risk for severe mental illness.

A Provincial Inter-Ministry Working Groupco-chaired by MOH and MCF was identi-fied to direct the Early Psychosis Initiative(EPI). Its overall purpose was to initiate aprocess for ongoing regional inter-ministryprevention and intervention efforts for thispopulation. Partners with MOH and MCFinclude regional health authorities,Ministry of Education, regional counsellingand special service representatives, BCSchizophrenia Society and the CanadianMental Health Association. Coordinationand implementation leadership is providedby the Mental Health Evaluation andCommunity Consultation Unit (Mheccu), a Division of the Department of Psychiatry,University of British Columbia.

Project Director:Tom Ehmann, Ph.D. Phone:(604) 877-3119Email:[email protected]

Project Coordinator: Josephine Hua, B.Sc. Phone:(604) 822-1642Email:[email protected]

The British Columbia Early Psychosis InitiativeMheccu, University of British Columbia2250 Wesbrook MallVancouver, BC V6T 1W6Web site:www.mheccu.ubc.ca

Regional component activities were projected to include awareness education, clinical training, risk prevention and community networking to improve identi-fication, referral, treatment, follow-up andsupport services for young people withearly signs of severe mental illness andtheir families.

PHASE ONE IMPLEMENTATION (1999/2000)Mheccu was contracted to assist theWorking Group in planning and managing the implementation of EPI. At the regional level, lead MCF and HealthAuthority representatives were identifiedto work with Mheccu and the WorkingGroup to advise and collaborate on thedevelopment of EPI.

Based on the above processes, two types of regional initiatives were established. The first type labelled, “Strategically-Targeted Initiatives” (STIs) involved a total of $552,922 allocated across all 18 Health Regions in accordance with a formula developed by the MOH, theWorking Group and Mheccu in consulta-tion with the regional representatives.

Funding was allocated partially (50%) on the basis of the size of the target population in each region (the 13 to 30year old regional populations); and alsoallocated (50%) to ensure that each region had a basic allocation sufficient to implement STIs. The awards ranged from $20,500 to $71,300.

Regions were required to include basic education and training activities addressing the following priorities: early identification, clinical skill buildingand improvements in service deliveryplanning that would be reflected, in part,in integrated regional comprehensive service protocols involving inter-ministryproviders.

22BRITISH COLUMBIA EPI

The second type of initiative labelled“Demonstration Projects” (DPs) involved a total of $300,000 allocated to selectregions. Through a competitive process, the following 5 regions or macro-regionswere funded to conduct projects designed to implement current best practices in earlypsychosis intervention during the 2000/01fiscal year: South Fraser, Central VancouverIsland, Vancouver/Richmond, North Westand Okanagan/Similkameen. Funding allo-cations ranged from $19,000 to $81,000.

To assist regions in implementing theirregional initiatives and projects, Mheccudeveloped a series of educational materialsand a web site (www.mheccu.ubc.ca). Mostof the materials developed are currentlyavailable to the public free of cost on theweb site.

PHASE TWO IMPLEMENTATIONMCF and MOH announced additional one-time grant funds totalling $350,000 toMheccu to further the development of EPI($200,000 from MCF; $150,000 from MOH).The primary goals to be attained with these funds are:

1. The development and dissemination of a document outliningthe goals and procedures for implementing best current practicesin early psychosisThis document is a very important element,along with the EPI Framework, in mappingout service directions and guiding everydayclinical practices.

2. Intensive and ongoing clinical training organized by MheccuA number of comprehensive and sophisti-cated assessment and treatment approacheshave been developed around the world.Service providers in B.C. deserve support in learning and implementing these procedures. The Mheccu training will bemuch more in-depth and practical than the types of sessions generally presented in Year One. The training will focus on skill development among the attendees. In order to provide a high quality educational experience, attendance will be limited. Regional EPI committees willdecide which service providers from eachregion will attend. The underlying objective is to establish pockets of clinicalexpertise in early psychosis across theprovince – establishing an interactive “network of excellence”. It is envisioned

that clinician specialists will not work in isolation as regular communication will bedeveloped among clinicians, tertiary centresand local experts. Given regional coopera-tion, these clinicians will be able to provideservices (e.g., in-home assessment and treat-ment) that are not normally conducted.

3. Further development of educational materials and otherresources including:• Advanced training materials • Web site enhancement (including

discussion groups)• Modification and translation of materials

to make them more culturally appropriate• Support to the Ministry of Education’s

school counsellor training on early psychosis

4. Evaluation of Year 1 Strategically Targeted Initiatives and theDemonstration Projects

5. Continuation of regional initiatives (e.g. Year 1 StrategicallyTargeted Initiatives) In order to support the continuation ofregional EPI initiatives, $130,000 will bedirectly distributed to the 18 health regions.These funds are to be utilized to further thegoals of the Strategically Targeted Initiativesas outlined in Year 1. These include work on:systemic issues (i.e., regional committee formation, referral pathway refinement,child-adult system bridging, etc.), identifica-tion training and clinical skill building.

23BC EPI REGIONAL

CENTRAL VANCOUVER ISLAND There are two components to the project:

Assessment in Early PsychosisTo examine the predictive validity of neuropsychological measures, intake psychological assessments of persons seenat the Victoria Early Psychosis Program willbe compared with functional outcomemeasures taken one year after discharge.Also, local assessment teams acrossVancouver Island will be trained in com-prehensive multi-disciplinary approaches to early psychosis assessment.

Non-Urban Pilot ProjectThe On-Board Program at Duncan will beevaluated as a model of rural service deliv-ery. The On-Board Program is intended topromote early psychosis awareness; optimal

On-Board Contact:Margaret Derocher,On-Board Coordinator

BC EPI RegionalDemonstration Projects

CENTRAL VANCOUVER ISLAND

access to treatment services provided in the least restrictive environmnent; and the development of consultative and education services to rural health practitioners. Team members include a co-ordinator, psychiatrists, an occupationaltherapist, case managers and psychologists.Program components include direct accessto initial triage, intake assessment within36 hours of referral, multi-disciplinaryteam assessment, assertive case manage-ment for up to two years, group therapyfor clients and families, and assistance with rehabilitation goals and access toservice. The On-Board Program is especially concerned with bridging the service delivery gaps that can occur between child and adult mentalhealth systems.

Phone:(250) 709-3040Email:[email protected]

NORTH WESTEarly identification and intervention ofpsychosis in the North West is impeded by the scarcity of psychiatric services inthis region. The project consists of theintensive training of a local pediatrician in first-episode psychosis assessment

and treatment. This pediatrician wouldthen provide both direct services to first-episode clients and act as a regional consultant for family physicians and mental health clinicians working with first-episode clients.

Contact: Marsha Lloyd


NORTH WEST

Phone:(250) 638-2202Email: [email protected]

BC EPI Regional Demonstration Projects

OKANAGAN SIMILKAMEEN

Phone: (250) 860-7549Fax: (250) 868-7791Email: [email protected]

Contact:Alice Jensen,Early Psychosis Coordinator

OKANAGAN SIMILKAMEENThis region in south central BritishColumbia represents a catchment area ofapproximately 110,000 people. Before thisproject began, the wait for appropriatetreatment was often extensive, especiallyfor non-urgent cases. The main objectives

of this project were to: promote the earlyidentification and treatment of symptomsof psychosis; reduce delays and improveaccess to treatment; reduce the frequencyand severity of relapse; reduce the burdento caregivers and promote family well-being; and reduce the incidences of

24BC EPI REGIONAL

secondary morbidity and disruptions tosocial and vocational functioning. In orderto build community awareness of this initiative, educational seminars have beenprovided to as many service providers aspossible, including the dissemination ofeducational materials.

This is a community response project thatwill be in service from June 2000 to March31, 2001. It involves developing the follow-ing service for clients who are experiencingtheir first episode of psychosis and theirfamily members (or other such caregivers):• A rapid response team will conduct

initial assessments in the person’s homeor other community setting (includingthe hospital) within a 24 hour period for acute cases and within a one-week period for non-acute cases. Both adult and adolescent cases will be accepted.

• A psychiatric assessment will be conducted within a 48 hour period.

• Treatment may involve home or community-based treatment by a mentalhealth clinician (daily to bi-weekly visits).

• An integrated treatment approach willinvolve the client, family, family physician, psychiatrist, psychologist,occupational therapist, and other professionals as required.

• Education of both the client and familymembers is seen as an important component in this treatment approach.

• Once the individual is stabilized, theywill be offered the support of a trainedpeer support worker.

Data being collected include rate of inappropriate vs. appropriate referrals,compliance with medication or psychosocial interventions, psychologicaltesting results (every three months), reintegration to normal routine, and satisfaction of both client and family members with the service.

Contact:Karen Tee,Demonstration Project Coordinator


SOUTH FRASER

Phone: (604) 951-5844Fax: (604) 951-5917Email:[email protected]

SOUTH FRASER The South Fraser Region has a populationof 575,000 and represents a range ofurban and rural areas. Prior to thisdemonstration project, people wouldaccess services through a variety of routes.One of the main objectives of this projecthas been to establish a single point ofentry to assessment and treatment foryouth and young adults suspected ofexperiencing a first episode of psychosis.The program offers services to persons 13 to 30 years of age. The single point ofentry intake process makes access easierand there is no waitlist for those at riskfor a first episode of psychosis. Referralsare accepted from families and individu-als as well as a variety of professionals inthe community. The intake clinician triesto make contact with the referring sourcewithin 48 to 72 hours.

Services are provided by a specializedearly psychosis clinician, mental healthclinicians, and psychiatrists. Each of thefive communities in the region has anidentified mental health clinician and apsychiatrist who undertake primary careof each case. In addition to psychiatricand psychosocial interventions, psychoe-ducational sessions are provided to clientsand their families on individual andgroup bases. Education and training pro-vided to professionals and communityagencies through the EPI educational ini-tiative have helped to support early iden-tification and case referrals to the project.

The project has two additional compo-nents: case finding - which is directed attwo targeted high risk populations aged13 to 30 (genetic risk and/or substanceabuse risk); and, a treatment comparisonstudy evaluating the impact of psychoed-ucation group interventions.

VANCOUVER/RICHMONDThere are three components to this project:Appointment of a Regional Case-Facilitator This individual will act as a resource forfront line workers, will advise about themanagement of individual cases and brokerneeded services when a provider is unableto deliver such services.

First-Episode RoundsMonthly rounds for professionals to present and discuss challenging cases.

25BC EPI REGIONAL


VANCOUVER/ RICHMOND

Contact:Miriam Cohen,CoordinatorWeb site:HOPE – Helping to OvercomePsychosis Earlywww.hope.vancouver.bc.ca/hope/

Phone:(604) 822-9732Email:[email protected]

Interactive Web SiteThe web site will provide general informa-tion and responses to specific questionsabout diagnosis and management of earlypsychosis to clients, family members andfront line professionals.The project provides consultation, assess-ment, initial treatment, support, educationand resource materials for clients, theirfamilies and the community. Clinicians can refer directly to the case facilitator.The program is accessible to clients aged 13 to 30.

26CMHA NATIONAL

CMHA’s early psychosis intervention project, funded by the Population HealthFund of Health Canada, is a 26 monthnational initiative which began in February1999. Clinicians from clinical/research sites in Alberta (Calgary), Ontario(Hamilton, London, Toronto), and NovaScotia (Halifax) are among the advisors to the project.

The project is intended to raise awarenessamong professionals, families and othercommunity members regarding the impor-tance of early psychosis intervention, andpromote access to appropriate first-episodeservices, with a focus on youth. Towardthis end, project activities are centred onthe development and dissemination of educational resource materials, the facilita-tion of local early intervention activitiesthrough three CMHA sites, and the development of a national network ofinterest and information-sharing.

In terms of resource materials, the projecthas produced a series of three pamphletsand an introductory document on earlypsychosis. The pamphlets are available inEnglish, French and Chinese. The projecthas also provided support for the produc-tion of a national, first-episode familynewsletter. A video resource for parentsnew to the experience of psychosis in thefamily is now available. Finally, this Guideis also a product of the project. Most ofthese materials are available on the CMHAweb site (www.cmha.ca) in both officiallanguages.

The three CMHA sites participating in theproject are: Alberta South Central Region in Calgary, Alberta; the provincial-levelManitoba Division; and Fredericton/Oromocto Region in Fredericton, NewBrunswick. Sites were chosen for theirregional representation and in order toreflect a range of readiness and capacity

Phone:(416) 484-7750Fax:(416) 484-4617Email:[email protected] site:www.cmha.ca/english/research/projects.htm

Canadian MentalHealth AssociationNational Office2160 Yonge St.,3rd FloorToronto, ON M4S 2Z3Contact:Elizabeth Lines,National Project Manager

for early psychosis activities. In Calgary,CMHA personnel have been workingdirectly with staff from the Early PsychosisTreatment and Prevention Program atFoothills Hospital to train high schoolteachers, counsellors and other gatekeepersin early identification skills and promoteaccess to the Foothills program. InFredericton, through the work of the localproject working group and with the sup-port of the provincial government, clinicalservices are being reorganized to accommo-date early psychosis services and the education of mental health professionals,gatekeepers, and the community at large is underway.

The province of Manitoba does not yetprovide a coherent set of services for young people with early psychosis. There,a project steering committee, representinga wide range of stakeholders, has beenworking to raise awareness regarding theimportance of early identification and theneed for appropriate services for youth.Key objectives include community education, gatekeeper training, and service improvement. A family supportgroup, modelled on the PEPP group (seeLondon, Ontario program description) hasbeen initiated by family members in the Winnipeg region. These families are linking with families in London (Ontario),Halifax (Nova Scotia) and elsewhere in thecountry to establish a national first-episodefamily network. The family newsletter (see above) is a component of this nationalnetworking initiative.

Through its broad dissemination ofresource materials, facilitation of nationaland local level alliances, and site-basedactivities, CMHA’s national project hasbeen helping to build awareness of theimportance of early psychosis interventionacross Canada.

Calgary Site Coordinator: Sandy BrayPhone: (403) 297-1716Email: [email protected] Site Coordinator: Sharon MulderPhone: (204) 878-9239Email: [email protected] Site Coordinator: Jean McBrinePhone: (506) 458-1803Email: [email protected]

27ONTARIO WORKING GROUP

The Ontario Working Group on EarlyIntervention in Psychosis is made up ofindividuals and organizations with the goal of developing an effective treatmentand support system for the early stages ofpsychosis. The group is committed tobringing the benefits of early treatment to all citizens of Ontario who experiencethe onset of psychosis and to providingsupport to their families. The WorkingGroup is also committed to a partnershipapproach with government and the privatesector to reach its goals.

The members of the Ontario WorkingGroup on Early Intervention in Psychosisreflect a variety of mental health disciplines, families, and consumers.Departments of Psychiatry at theUniversity of Toronto, the University ofWestern Ontario, McMaster University, andthe University of Ottawa are involved aswell as clinical sites in London, Hamilton,and Toronto. The Schizophrenia Society ofOntario and the families involved in theearly intervention program in London arealso part of the Working Group

The Canadian Mental Health Association at both the national and Ontario levels is also involved. The Working Group iscoordinated and supported by theCommunity Support and Research Unitand the Schizophrenia and ContinuingCare Program at the Centre for Addictionand Mental Health.

Contact:John TrainorDirector,Community Supportand Research Unit

Centre for Addiction and Mental Health1001 Queen Street W.Room 2075Toronto, Ontario M6J 1H4

The Working Group has proposed a two-phase plan to develop a comprehensiveearly intervention capacity in Ontario. The first phase will feature the develop-ment of four Early Intervention Treatmentand Resource Centres. These centres will bepartnerships between family organizationsand clinical treatment programs and will deliver assessment and treatment, publiceducation, community development andconsultation services to the broader mentalhealth system. Phase one will also includea province-wide planning process to laythe groundwork for early interventionacross Ontario. Phase two will see theimplementation of this expanded program.

Phone: (416) 535-8501 x2071Email: [email protected]

The Ontario Working Group on Early Intervention in Psychosis

Following are the diagnostic catagoriesreferred to in this Guide. For comprehensivediagnostic definitions, readers are directedto the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (see reference below).

BIPOLAR DISORDEREssentially reflects a disturbance of affect or mood that can be accompanied by symptoms of psychosis.

DELUSIONAL DISORDERA type of psychosis consisting of very strongand fixed beliefs in things that are not true.

DRUG OR SUBSTANCE-INDUCED PSYCHOSISDrugs such as marijuana, LSD, ampheta-mines and alcohol can sometimes cause the appearance of psychotic symptoms.Symptoms usually abate once the effects ofthe drugs wear off. However, the symptomsmay still require medical treatment.

PRODROME OR PRODROMAL SYMPTOMSPre-psychotic symptoms, or warning signs,that occur prior to the onset of psychosis.The full complement of prodromal symp-toms is extensive, and can include suchsigns as suspiciousness, depression, sleepdisturbances, social withdrawal, lack ofattention to personal care, and reduced levels of functioning in school or at work,among others. The concept is relevant tothe onset of the first episode and to relapse.

PSYCHOSIS NOS (PSYCHOTIC DISORDER NOT OTHERWISE SPECIFIED) Psychotic symptoms are present, but there is insufficient or contradictory informationthat preclude a more specific diagnosis.

SCHIZOAFFECTIVE DISORDERA disorder characterized by episodes ofmania and/or depression in addition tosymptoms consistent with schizophrenia.

SCHIZOPHRENIFORM DISORDERA form of schizophrenia that is character-ized by a duration of less than six months.This disorder may resolve or may persistand progress to other psychiatric diagnoses,including schizophrenia.

SCHIZOPHRENIA SPECTRUM DISORDERS An umbrella term that typically includesschizophrenia, schizophreniform andschizoaffective disorders.

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Adapted from:

Czuchta, D., & Ryan, K. (1999). First episode psychosis:An information guide. Toronto, Canada: Centre forAddiction and Mental Health, Clarke Institute.

http://mentalhelp.net/disorders – diagnostic criteriasummarized from American Psychiatric Association.(1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: AmericanPsychiatric Association.

McGorry, P.D., & Edwards, J. (1997). Early PsychosisTraining Pack. Macclesfield, Cheshire: Gardiner-Caldwell Communications Ltd.

GLOSSARY

A Guide to Canadian Early Psychosis Inititative

Documents

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