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 Centre for Addictionand Mental Health |
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CAMH’s Home Intervention for Psychosis (HIP) Team“Almost everything the hospital can provide, we can provide in the community.” At CAMH, we recognize the importance of providing early, holistic, client-centred care that starts from ‘where the client is’. The Home Intervention for Psychosis (HIP) Team—serving young people experiencing their first episode of psychosis—exemplifies our model of care. HIP brings CAMH hospital services to where the client lives, a model widely seen as the way of the future.
HIP is an interprofessional care team of nurses, a social worker and a psychiatrist who are passionate about what they do: delivering an in-home specialized treatment, rehabilitation and education program for young people experiencing their first episode of psychosis and their families. Working from referrals, the HIP team goes out to visit those clients who might never come through the doors of the hospital, slowly gaining the client’s trust and developing a therapeutic relationship on the client’s own turf, one visit at a time. Troy and his parents Ron and Deborah are current HIP clients. Troy, 33 and undiagnosed, refused to leave his room in his parents’ home for two years, often shouting incoherently and going days without eating. His mother Deborah remembers that “it was like being in hell, and there was nothing we could do”. Within a month of the HIP team first knocking on their door, the family saw a difference in Troy, and “in only five months we see a total change,” said his father Ron. “They’re bringing back my son…who’d disappeared.” There’s a lot at stake for HIP clients. It is now recognized that with prompt identification and treatment, a huge majority (over 80%) of young people with a first episode of psychosis will experience a remission of symptoms within the first year. It is vitally important to treat symptoms as early and as effectively as possible in order to provide the best chance of a good long term outcome. While there is a window of opportunity early in this chronic illness to avoid its potentially downhill trajectory, most patients are not motivated to come in to seek treatment.
“Home intervention allows us to take advantage of the window of opportunity,” said Dr. Ofer Agid, the team’s psychiatrist. The advantages of bringing the hospital’s services into the community There are lots of other advantages to home interventions, including holistic care. “When clients come to the office, you only get part of the story, “HIP RN Rolando Vasquez said. “But when you see a person in the community, you are seeing the whole picture.”
“In the community it is much easier to see someone as a person: a son, a spouse, a neighbour, a student—a social being in the context of their family, school or work, and not only as ‘a psychiatric patient’. You are seeing the family’s distress and how much they need help. You are seeing what the person will need to get back to work or school.” Troy’s family agrees. “People feel more comfortable at home,” said Deborah. “More at ease, more willing to talk. When I took Troy to the hospital, it was a scary experience for me. The nurses were locked in a room, and other patients were hollering.” “With earlier identification of symptoms and better tolerated treatments, the majority of young people can be treated in their homes rather than the hospital,” said April Collins, Administrative Director of CAMH’s Schizophrenia Program. “This has marked advantages of normalizing the illness experience, reducing the trauma, alienation and stigma still associated with psychiatric hospitalization.”
The interprofessional HIP Team is structured to intervene as early as possible in the course of the illness, provide treatment in the home, minimize the distress of young people and their families and get the client back to what they were doing before the first psychotic episode. The psychiatrist conducts the assessment in the home, prescribes medication there, and makes adjustments on an ongoing basis to minimize any side effects to ensure the client is stabilized with a good response. The Social Worker or RN educates the client and family about psychosis, and helps them sort through complex practical problems caused by the illness (sometimes including legal problems or problems with the police). The interprofessional team collaborates on an individualized care plan with community partners to get the client back to school or work. “Psychosis is something new to us, and we didn’t know how to handle it. It’s very important to understand—to know what it is,” Ron said. “The doctor explains the process of what’s happening. We’re starting to understand the difference between the psychology and the reality, to see what Troy sees, to put the whole puzzle together and understand the whole thing.” Supporting the family is a key part of this model. “Unlike other illnesses, treatment for psychiatric illnesses (like first episode psychosis or schizophrenia) doesn’t require fancy machines or a hospital setting,” notes Ofer Agid. “Almost everything the hospital can provide, we can provide in the community. And most patients will never come to the hospital.” Rob Peach, a Social Worker on the HIP team who also runs a family therapy group, points to multiple barriers that can prevent high risk people from coming to CAMH. “These include poverty, disabilities, and being a member of a marginalized group reluctant to come here.” The result is untreated illness and suffering. “I was reluctant to go to a ‘mental hospital’ because I was afraid they would lock Troy away,” Deborah said. “Before finding this [HIP Team], for two years we couldn’t get the proper help.” Meet the HIP Team The HIP Team draws strength from its members’ diversity. “We come from all over the world, representing different cultural communities and speaking different languages,” said Rob Peach. “We reflect the Toronto that is outside our door.” HIP Manager Diane Kirsopp is proud of her collaborative team, who are passionate about the recovery model and deeply committed to the work they do and the way they do it. “Psychosis is not a 9-5 illness and this is not a 9-5 job,” offered RN Mamode Burtally, another member of the team. “We all carry pagers and cell phones, and check our voice mail frequently. We have an on call system for after hours crisis intervention, and all disciplines can be reached 24/7.” Troy’s family certainly appreciates the strong level of support they receive from HIP RN Michael Bernard. “In an emergency situation, or when I need to ask a question, I can call Michael. Or when Troy needs meds: call Michael.” Deborah said. “He is so supportive. You have no idea how grateful I am that Michael got us help and totally changed our family for the good.” The HIP team’s psychiatrist puts their work into its larger context: “This is a chronic illness with an acute phase, and up until now, the investment of resources has been in the acute phase, with less attention paid to the chronic nature of the illness,” said Ofer Agid. “We in the HIP Team are doing relapse prevention.” The leadership of CAMH sees HIP as a model for the future. “The Schizophrenia Program is transforming its model of care delivery in a manner which will better support the emotional and functional recovery of persons experiencing a psychotic illness,” said Dr. Rohan Ganguli, EVP of Clinical Programs. “There are phases of such illnesses and specific clinical situations which are best treated in inpatient settings. However, what the HIP experience has taught us is that a lot of what is traditionally offered only in inpatient settings, may actually be more effective when delivered while the person continues to live in the community.” “For most individuals this means that they will spend more time in the least restrictive environment. An additional benefit of this approach is that capacity of the hospital to accommodate those most in need of inpatient services will increase.” One family’s success story Recently, Troy surprised and delighted his family by leaving the house to attend his sister’s wedding, something that would have been unheard of only a few months ago. “He is able to reason again and interact—he couldn’t express himself before,” his father Ron said. “I feel a lot calmer. Plus the pills help me sleep at night. The dreams are easier. I’m able to focus more on my work,” Troy said, referring to the striking artwork which showcases his creative talent. Troy is talking about the future and looking forward to expanding his activities. Michael Bernard has connections with a number of community programs and will help Troy get on the path to meeting his goals. After two years of hell, the HIP Team knocked on their door and brought health to their family. “It’s amazing what they’ve done. They’ve helped Troy a lot. He used to push us away all the time; now it’s down to about 3% of the time. Now there is peace and harmony,” Ron smiled. “My son came back to me.” |
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Last updated: Jan 12, 2010 9:01 AM Published: Nov 07, 2011 6:12 PM ID#P48080 |