Early Psychosis Intervention: A Culturally Adaptive Clinical Guide

9. Enhancing Psychosis Detection through Gatekeepers

9 Enhancing Psychosis Detection through Gatekeepers Chi-wing Law One of the most significant challenges in running an early assessment and intervention programme for psychosis is how readily people with untreated psychosis can get in touch with services. According to the annual statistics of the Early Assessment and Services for Young People with Psychosis (EASY) in Hong Kong, schools and youth services social workers and counsellors contributed to more than 10% of all referrals, with the vast majority of cases assessed and managed on an outpatient basis. Looking into details of the pathway to care, more than 20% of all clients had had contact with social workers at some point of time before they were first seen by EASY. This shows that social workers and counsellors are important frontline gatekeepers, with whom early psychosis services need to collaborate closely to ensure a comprehensive coverage of referrals of potential clients suffering from psychosis. Important Roles of Counsellors and Social Workers Clients in their prodromal or initial phase of psychotic illness may be experiencing rather non-specific symptoms such as mood and personality changes, with resultant influences on their academic or work performance, as well as their relationships with family members and friends. These could easily be mistaken to be part of the schooling problems, adolescent crises, or family turmoil. Family and school social workers are most likely to be the first contact in this phase of the pathway to care. Social workers have a wide network of contacts with those who are most deprived and in need. These include, for example, young people with a substance abuse problem and unengaged youth at home. These two groups are at higher risk for psychotic disorders, and yet are difficult for ordinary psychiatric services to reach. The more extensive social networks and in-depth outreach 94 Chi-wing Law services known to social workers allow these potential clients to be reached more easily. With the rapport and trust developed with their clients, counsellors and social workers are well placed to assist engagement of the client with an early psychosis service. In the subsequent course of treatment and rehabilitation, counsellors and social workers could also help in monitoring the person’s condition in settings outside the clinic, such as at school and in the community. This connection would provide medical professionals with a more thorough understanding of any state of remission and recovery. Potential Challenges in Collaborations with Frontline Gatekeepers As with any kind of collaboration where multidisciplinary parties are involved, a number of potential challenges need to be tackled. Increasing awareness in identification of psychosis among youngsters with various social or psychological problems Training courses Understandably, counsellors and social workers need to handle a huge variety of problems in young people and psychosis is only one of the many health issues they have to address. Frequent updates on clinical care and awareness building activities need to be offered repeatedly through different channels to keep the staff ready and able to respond effectively to any presenting psychosis. Specific education and publicity programmes are essential and may include in-depth discussions on case scenarios, or workshops on practical skills for handling people with psychosis. Education on psychotic disorders may also become core training for social workers and counsellors. Quick references and accessories Materials in the form of brief information booklets, CD-ROMs, etc., would be helpful for quick reference in case of need. More in-depth information could be provided through well-designed and preferably interactive web pages. Small souvenirs such as ball pens, bookmarks, and paper files with the web address Enhancing Psychosis Detection through Gatekeepers 95 and telephone number for assessment service printed on them can serve as easy reminders for target frontline workers. Easily accessible services The most important factor of all for enhancing frontline gatekeepers’ support of early identification would be the availability of a simple, efficient referral channel for flexible and user-friendly service provision. This step would be useful in overcoming any perceived hurdles in referrals to medical specialists, a long-held concept for many people. Early psychosis services aim at providing flexible arrangements for clinical assessments of suspected cases of psychosis as promptly as possible. In cases where the potential client shows strong resistance to assessments in clinical settings, attempts can be made to collaborate with NGOs (see Chapter 22, “Working with Non-Governmental Organizations in Early Psychosis”), so that the first assessment can be done in...