Early Psychosis Intervention: A Culturally Adaptive Clinical Guide

19. Community Psychosocial Intervention in Early Psychosis

Overview of Psychosocial Intervention First-episode psychosis—in the main, schizophrenia—arises often during the developmental stages of early adolescence and early adulthood (Rinaldi et al., 2010). It is also during these development stages that education, employment, self-identity, and formation of relationships tend to occur (Basset et al., 2001). Due to the impact of the illness, adolescents with early psychosis commonly experience social exclusion, low self-esteem, and decreased social and occupational functioning (Cotton et al., 2011). The three essential elements in managing early psychosis are early recognition and assistance, initial assessment and treatment, and promoting recovery (McGorry, 2002). Programmes have to be comprehensive in supporting the needs of young people with psychosis (Bertolote & McGorry, 2005). Appropriate treatment interventions should be carried out for functional outcomes rather than just for symptom remission. Therefore, by engaging in psychosocial groups, patients can be facilitated to acquire the skills required to perform their age-appropriate roles. In 1995, the WHO defined psychosocial rehabilitation as a comprehensive process, which strives for individuals who are impaired, disabled or handicapped by mental health problems to reach their optimal level to function independently in the community (WHO, 2001). The primary goal of psychosocial intervention is to restore a person’s ability for independent living, socialization, and effective life management. The key principles in psychosocial intervention (Hughes & Weinstein, 2000) are: 1. Hope—belief that one has control over his or her life. 2. Self-determination—empowerment required for one to actively participate and assume responsibility for making everyday life decisions. 19 Community Psychosocial Intervention in Early Psychosis Yogeswary d/o Maniam 224 Yogeswary d/o Maniam 3. Community approach—network of community support, including the community that the patient lives and works in, and the community of his or her peers. 4. Assessment and intervention needs to be individualized, activities needs to be age-specific and relevant. The core components of psychosocial rehabilitation or intervention (Hughes & Weinstein, 2000) are: 1. Social rehabilitation—to look into social skills, social interaction, and recreation through group activities. 2. Vocational rehabilitation—to improve tolerance, concentration, instruction following, and work attitude through pre-vocational training, vocational training, and career counselling. To enhance job acquisition and retention, job placement and ongoing job support are essential. 3. Residential and housing services—to look into step-down housing and community housing for patients. 4. Education about mental illness and medications—the need for compliance, identification of relapse symptoms, and to educate patients and their family on medication side-effects. 5. Physical health. 6. Intensive case management. 7. Family support. Distinctions in East and West Approaches Historically, mental health services have been placed in inpatient settings but in recent years, the focus has shifted towards psychosocial rehabilitation services in the community (Pillai et al., 2010). This approach in the West, from an Indian perspective, transfers great empowerment and choice to clients to make their own decisions in treatment planning. In contrast, in the East there is still an element of the traditional approach where a team decides what is essential for the patients. However, this approach is fast disappearing and increasingly, patients are given the opportunity to make informed choices. Also, in the East, “psychosocial rehabilitation models have been developed using primary care, family support, back-up psychiatric support, community supervisors and factory rehabilitation intervention” (WHO, 2001, p. 63). There is still an element of clubhouse models and vocational training in the East whereas in Community Psychosocial Intervention in Early Psychosis 225 the West, incorporated supported employment models such as Individual Placement and Support are commonplace. Psychosocial Intervention in the Early Psychosis Intervention Programme (EPIP) in Singapore In the Institute of Mental Health in Singapore, the early psychosis team adopts a multidisciplinary approach and provides early detection and intervention for individuals with early psychosis as well as those at high risk of developing psychosis, through a personalized, comprehensive, and accessible service. This facility engages patients in a variety of interventions, and one such service is Club EPIP (for individualized psychological therapy, see Chapter 14, “The PASTE that Binds: Culturally Relevant Psychological Interventions for FirstEpisode Psychosis Individuals in Singapore”). Club EPIP was formed in 2005, with the aim of integrating and supporting patients with early psychosis in the community. The Club focuses on functioning and psychosocial recovery. The motto of Club EPIP in 2010 was to foster greater independence, a sense of belonging, and social responsibility in individuals . The pledge that clients came up with...