Early Intervention in First Episode Psychosis: A Service User's Experience

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Schizophrenia Bulletin vol. 43 no. 2 pp. 234–235, 2017
doi:10.1093/schbul/sbv227
Advance Access publication January 12, 2016
© The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.
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FIRST PERSON ACCOUNT
Early Intervention in First Episode Psychosis: AService User’s Experience
StephanieAllan
Institute of Health & Wellbeing, University of Glasgow, Glasgow G12 8QQ, Scotland.
To whom correspondence should be addressed; tel: +44 (0)141 211-0690, e-mail: 2013906a@student.gla.ac.uk
I had my rst severe psychotic episode in early 2010. Two
years prior to this my thoughts had began slowing down.
Normally, thinking about doing an action and then mov-
ing the required body part happened simultaneously.
Now there was a gap. Iwas a radiotherapy student and
since operating X-ray machinery requires a smooth ow
of decision making and intricate movement. These slow
thoughts made me a hazard. Once Igave up my degree,
Ihad no-where to go during the day and would lie in bed.
My general practitioner thought I was depressed and
gave me antidepressants. We know now that Iwasn’t and
Ihad prodromal psychosis. Eventually the slow thoughts
took over my mind and Ibegan hearing voices that were
frightening.
My memories from the rst month of this episode are
fairly hazy. This is a common nding in those who have
schizophrenia and poor memory is probably the most
frustrating ongoing symptom. However, on this occasion
it became possibly adaptive. Iseemed to wake up one
day and be under the care of ESTEEM: a specialist early
intervention team for people ages 16–35 experiencing rst
episode psychosis in Glasgow. I spent 2 years with this
service and treatment was often intense. The success of
early intervention teams in producing better clinical out-
comes is generally well recognized but not without con-
troversy. However, there seems to be a lack of personal
accounts of what such a service is like for those who use
it. Therefore, Iwould like to share my own experience in
thisarea.
Looking back on 2010–2012 Ihave a sense of immense
gratitude. While Iwas with ESTEEM, Ihad taken all of
my treatment for granted and was unaware that the inten-
sity of the support that Iwas given was quite unusual.
My support worker would regularly take me out for a
tea to ensure that Iwas leaving the house. While Iwas
hospitalized, Iwas taken out for the day with other ser-
vice users to the bowling alley and the cinema to make
the stay less tedious. Icould text any time if Iwas strug-
gling which was powerful for someone who was paranoid
about using the phone. It was not always smooth sailing
and since Iwas paranoid it took a while to build up trust
and accept treatment. My support workers wanted to
know what Iwas like before hallucinations made me feel
threatened and act snippy. Islowly realized these ques-
tions were not asked to irritate or shame me for my low
functioning but to help me get back to where Iwanted
tobe.
From their website, ESTEEM describe themselves as
“working within a framework that believes recovery from
psychosis is possible. Clients are encouraged to engage
in a holistic, individualized, recovery-focused approach
to their care needs. This is facilitated through collabora-
tive, therapeutic interventions between the client, their
carers and the multi-professional team.” Speaking to
friends with schizophrenia who have not received early
intervention Ibelieve it is the focus on relationships that
differentiates the treatment I received from standard
care. My family ties were in complete disarray because of
my psychosis. I had distanced myself so much from the
group that no one noticed that Iwas in hospital for well
over a week despite living nearby. Iquite liked it that way.
Upon nding out that Iwas unwell my family were at the
hospital within 1 hour and keen to get involved with my
care. Once ESTEEM realized that Ihad no reason other
than psychosis for shunning my family we were offered
therapy sessions together.
The sessions were once a week and in the evenings so
that my mother could attend around work. My psychia-
trist and support worker delivered all of the therapy.
With retrospect Ican understand myself to be lucky
that Behavioral Family Therapy (BFT) was delivered by
those who knew me best. Iwas already seeing my sup-
port worker a couple of times a week and the psychia-
trist at least once a month so we had already established
trust. Indeed, I felt that I could rely on them being
impartial should the sessions get heated. The Meriden
Family Programme website describes BFT as “essential
in all families where a member experiences serious men-
tal health difculties” due to the potential for relation-
ship dysfunction. We met for around 9 sessions which
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Early Intervention in First Episode Psychosis
mostly focused on the development of effective com-
munication skills, educating my mum on psychosis and
developing a “staying well” plan for myself so that my
family could tell if I was becoming unwell again. The
sessions were never overly formal and my psychiatrist
often made everyone a cup of tea to drink during them.
Despite my initial cynicism the benets of better com-
munication soon became apparent and Ibegan to enjoy
being around my family again and felt attached to them
once more.
Once family relationships improved I was given indi-
vidual sessions with a clinical psychologist to improve my
relationship with myself. Iwas ashamed at having devel-
oped psychosis and having delusions that stopped me
from using certain public transport. Iwas given a mixture
of cognitive behavioural therapy and “third wave” thera-
pies such as mindfulness in addition to being allowed to
vent! My resilience increased throughout the sessions and
by the time they nished Ihad a better opinion of myself
and was able to understand that psychosis was an illness
that could be treated and not some kind of supernatural
punishment. In addition to medication and supportive
therapies I was also given practical support in access-
ing sickness benets. Eventually, as discharge from my
2years of treatment drew close Iwas asked the big ques-
tions. What did Iwant to do now? Icould not go back to
my radiotherapy degree due to the medication Iwas on.
My support worker was very encouraging in my decision
to apply to study psychology inspired by my new experi-
ences. Ihope to work within psychosis research with a
special interest in applying community psychology meth-
odologies and utilizing my experiences. I am currently
being kindly supported in achieving this goal by support-
ive academics at my university.
I am now doing well in a way that is meaningful to
me. Iwork, study and have recently gotten engaged to
someone Imet during recovery. I still take medication
every day but Ihope to not have to do this forever. Five
years ago Iwanted to die and never left the house. This
is quite a turnaround and Iam grateful to early inter-
vention for aiding in my recovery. What about other
users of ESTEEM in Glasgow? Iwould like to share
the following quote from a Scottish Government report
regarding psychiatric hospital stays for rst episode psy-
chosis across all Scottish Health Boards. “There is clear
evidence that the prevalence of psychosis has a positive
correlation with levels of deprivation. Therefore, the
fact that NHS Greater Glasgow & Clyde has the low-
est number of bed days used and the shortest average
length of stay is of particular interest. Glasgow has a
specialist team for rst onset psychosis in place which
covers individuals from 16 to 35. This aligns with the
evidence base that such services result in a reduced use
of inpatient beds over the medium to longer time.”
While it is (of course) crucial to never overstate the
importance of research ndings, Ibelieve that my own
hospital stays were kept short due to the extraordi-
nary support Iwas given and early intervention has the
potential to shorten the distress felt by those who expe-
rience psychosis.
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