Mental+Health+-+Early+Intervention+or+Just+Plain+Intervening

=//__**Early Intervention Psychosis or Just Plain Intervening**__//=

Mark Tuazon n8352321 Tutor: Sophie Miller




 * //__Present Your Artefacts__//**

In more recent times there has been a rise in popularity and focus for early intervention as an effective treatment for psychotic disorders. While the consensus is that early intervention is an effective means of treatments, there are sceptics that are still under the belief that there is a lack in adequate evidence that proves early intervention actually works. Sceptics of early intervention psychosis have likened to fortune telling, where sceptics are not convinced that it is possible to foretell that someone will suffer from psychosis and that early intervention will aid positive outcomes. It is believed that early treatment especially amongst younger people may result in misdiagnoses and over-medication. The artefact is picture of an antique box for a magic 8 ball which I associate with the sceptics’ belief that early intervention is much like attempting to tell the future.


 * //__Name the public health issue central to your analysis__//**

This analysis will focus upon mental health treatment, with a special analysis upon the effectiveness of early intervention psychosis. Being underfunded and overlooked for many years throughout the national budgets, the 2011 federal national budget saw the mental health sector come out a major winner with a 2.2 billion funding boost. While many mental health advocates were overjoyed within the increased funding, many sceptics debate the effectiveness of early intervention programs. The review will be heavy focused upon early psychosis and the stages whereby early intervention are believed to be most effective as a treatment and preventative measure for psychosis. The review will also address the scepticism within each of these stages in regards to early intervention.


 * //__Literature Review__//**

According to the Australian Bureau of Statistics 3.2 million Australian had suffered from some sort of mental disorder within the last twelve months (ABS,2007). Of those 3.2 million, the greatest effected age demographic with roughly 26% of all recorded cases was between 16-24. This rate continually decreases through each increasing age demographic (16-24=26%; 25-34=25%; 35-44=23%). However when type of disorder was taken into consideration the age demographic of between 35-44 presented the highest prevalence rates for anxiety (17%) and affective (8%) disorders. The only disorder that did not demonstrate evidence of an increase in prevalence through age was with substance-abuse disorders (16-24=13%,(325,500); 25-34=7%; 35-44=4.5%). With all this in mind, it becomes easier to understand how early intervention treatment can effectively treat a large demographic.

Through more recent times the psychiatric community has begun embracing early intervention as practical preventative measure that can be implemented within the mainstream health system (McGorry, Killackey, Yung, 2008, p128). Early intervention procedures do not require dramatic and instantaneous exclusive breakthrough but more reflect health strategies with better access and early delivery of existing knowledge with the incorporation of new founded information. These procedures can be broken up into clinical stages whereby early intervention can still be incorporated as an effective treatment. These include; ultra-high risk, first episode and recovery or critical period. The ultra-high risk stage can be described as symptomatic stage prior to prepsychotic stage. It is the earliest point at which preventative measures can used to help prevent ongoing psychotic development. It should however be mentioned that those people that are identified as being ultra-high risk display a significant false positive rate for psychosis(60-80%)(Cannon TD, Cadenhead K, Cornblatt B,2008). Typically the rest simply develop and display other disorders such depression and anxiety disorders. This demonstrates why it is known to the psychiatric community that cases of psychosis are missed by prodromal clinics when at a ultra-high risk stage (Warner,2005).

Furthermore, from the ultra-high risk stage comes the first episode stage or first episode psychosis. The goal is to minimise the duration of untreated psychosis also known as DUP. The importance of DUP has been surrounded by a lot of controversy. Recent studies have proved that DUP can be both a marker and independent risk factor on the poor outcomes resulting from first episode stage. Such studies include “ Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: A critical review and meta-analysis” displayed results that found a greater response to antipsychotic treatment in patients that suffered from shorter duration of untreated first episode psychosis (Perkins, Gu, Boteva, Lieberman, 2005). The study had concluded that the duration of untreated psychosis maybe variable prognostic factor, that may lead to greater understanding of pathophysiological of schizophrenia and improved treatment strategies (Perkins, Gu, Boteva, Lieberman, 2005). While DUP can be seen as an important factor in treatment of psychosis, other studies have outlined how DUP accounts for a relatively modest change in overall outcome variance. A study conducted by Harris, Henry, Harrigan and et.al (2005) in which the relationship between the duration of untreated psychosis and its outcomes, found that along with DUP other important factors underlining importance of treatment included the accessibility and quality of treatment through early stages of psychosis. In reducing DUP two important factors are outlined; community awareness and mobile detection centres. A study conducted by Joa et al(2008) compared the DUP of two cohorts of patients. One group having had been exposed to informational campaigns regarding signs and symptoms of psychosis while the other had no recorded encounters. The results showed that within the group which had not been exposed to information campaigns had increased DUP of on average 15 weeks.

Following the first episode stage, comes the critical or recovery period. The period goals within this stage are to minimise disability and maximising functioning. Treatments goals are to use effective intervention procedures and managing effective medication. Here lies most of the scrutiny involved within early intervention treatments. There is a belief that with the difficulties in diagnosing psychosis there may be a development of over-prescriptions of dexamphetamines and other drugs. The threat is that by encouraging early intervention procedures to younger age demographics may result in higher rates of drug dependence. However Professor McGorry (2011) admits that over medication is a threat but reaffirms that early intervention is designed to minimise the need for medication and only provide such need medication when required.


 * //__Cultural and social analysis__//**

According to McGorry, Killackey and Yung (2008) the three factors that remain as obstacles to both the progress of mental health and early intervention are stigma, pessimism and the silence that continues to surround mental illness. The stigma involved with mental health may include situations where a person who may or may not be suffering from a mental illness is characterised through social stereotypes which then goes on to effect the interaction which may or may not result in a negative outcome (Horsfall, Cleary, Hunt, 2010). This ultimately may result in the person being treated less than a whole and not receive full social acceptance (Horsfall et al,2010). Three stigma main components are connected to mental illness; mainstream negative stereotypes, false evidence and signs of mentally ill people, and avoidance, mistreatment and discrimination against the mentally ill. Examples of negative mainstream stereotypes include statements or though process associated to mentally ill people being dangerous. An example of the second main component false evidence and signs of mentally ill people is when the thought process of people wrongly associate characteristics with signs and symptoms of mental health disorders. The third component avoidance, mistreatment and discrimination are often a result of the two main components. By focusing upon the early development it is McGorry, Killackey and Yungs (2008) belief that many second order issues associated with early psychosis such as stigma may be eliminated. By eliminating the stigma cased around mental health the silence that continues to surround mental health may be eliminated also. Programs such as ‘Headspace’ provide avenues where young people can access help in regards to mental health. Insel and Fenton (2005) identify mental disorders as a chronic disease for the young. Most adult mental disorders such as psychotic, anxiety, mood and substance disorders display onset from late adolescent and early adulthood. As aforementioned through the ABS statistics it is understood that anxiety and affective disorders progressively increase in prevalence through age. By promoting such programs and developing support and knowledge it will help eliminate the stigma that inhibits the required treatment that these people need. These programs are likening to strategies mention earlier that minimise the duration of DUP within the first episode stage.

It should also be mentioned not only does early intervention programs have the potential increase the quality of life of many people; it also has the ability to save the tax payer money. As of March 2009 the estimate for the cost of mental health annual in Australia was $20 billion dollars (ABS, 2009). This estimate included the estimated cost of loss of productively and labour force. One can only assume that by providing services such as headspace, will allow for better health outcomes for those suffering from mental illness, which will then lead to improve economic wellbeing for these people.


 * //__Analysis of the artefact and your own learning reflection__//**

The artefact of the picture of the antique magic 8 ball box allows me to reflect upon the ideas of sceptics and the scrutiny placed against early intervention psychosis. While the artefact doesn’t directly relate to mental health, it allowed me to critically think about the topic and breakdown each side of the argument in regards to the effectiveness of early intervention psychosis. Through the thorough review I personally believe that early intervention psychosis is an effective preventative measure for psychosis. I do not believe in the association between early intervention psychosis as an attempt to tell the future. I believe the sceptics are misinformed and failed to understand that early intervention is not design pre-empt psychosis within people but more so aimed to provide avenues for aid when it is required.

Throughout the this investigation I was able to further understand how mental health is not only a difficult for those who it directly effects, but it also effects and reflects upon the whole community. Mental health still proves as a vital and challenging health issues within the health sector. My investigation outlined early psychosis as a preventative measure that is effective and is currently being established within Australia.


 * //__References__//**

Australian Bureau of Statistic (2007). //National Survey of Mental Health and Wellbeing: Summary of Results, 2007.// Australian Bureau of Statistics McGorry, P. Killackey, E & Yung A (2008) Early intervention in psychosis: concepts, evidence and future direction. //World Psychiatry// 7 (3) 148-156. PMCID:PMC2559918 Cannon TD, Cadenhead K,& Cornblatt B (2008). Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America,. //Archives of general psychiatry//, 65 (1), 28. Warner, R (2005). Problems with early and very early intervention in psychosis,.. //British journal of psychiatry// 187 (48), 104-107. doi: 10.1192/bjp.187.48.s104 Perkins, D. Gu, H. Boteva,& K. Lieberman, J,A. (2005) Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: A critical review and meta-analysis,//The American journal of psychiatry//, 162 (10), p. 1785-1804. Harris, M., Henry, L., Harrigan, S., Purcella,R. Schwartza, O. Farrellya, S. Prossera &, A. Jackson, H.McGorry, P. (2005) The relationship between duration of untreated psychosis and outcome: An eight-year prospective study. //Schizophrenia research//, 79 (1), 85-93 Joa, I. Johannessen, O Auestad, B. Friis, S. McGlashan, T. Melle, I. Opjordsmoen, S. Simonsen, E.Vaglum &P. Larsen, T,K. (2008). The Key to Reducing Duration of Untreated First Psychosis:Information Campaigns//,. Schizophrenia bulletin//, 34 (3), 466-472 doi:10.1093/schbul/sbm095 Cleary, M. Horsfall, J.& Hunt, G. (2010) Stigma in Mental Health: Clients and Professionals//, Issues in mental health nursing//, 31 (7), 450-470. DOI: 10.3109/01612840903537167 Insel T,& Fenton, W (2005). "Psychiatric Epidemiology: It's Not Just About Counting Anymore". //Archives of general psychiatry//, 62 (6), 590-592

Mental Health – The undefined and hidden burden Charlotte Yates I find that your assignment reflects many of the same topics that had covered throughout my own assignment. Within my own assignment I briefly reflected upon the stigmatisation surround around mental illness. I believe you did a great job of outlining the issues with great sources throughout the literature review. I also believe that your final analysis of the cultural and social analysis where you outlined the concepts of individualist versus collectivism was a great analysis of the problems associated with living in an Australian individualistic society. I only wish I had incorporated this social theory within my own assignment. Great job with assignment. Mental Illness Medication – Is it as straight forward as it seems? Tamika Knight Great work on the wikipage and great work on outlining the mental health issue in Australia. The mental health issue within your assignment is clear throughout and you manage to reflect upon many topics within the mental health sector. I also believe your artefact of the song ‘Everything is alright’ clearly reflected the mental health issue. The many resources you used were very alarming and persuasive and reflected the importance of action within the issue very well. The assignment was definitely an interesting read, with a lot of clear sources and information. Great work on the great assignment.
 * Reflection **