The EPIS Family Education Programme

1. The EPIS Family Education Programme Gaby Judd Senior Psychologist, The Hornsby Early Psychosis Intervention Service

2. The Hornsby Early Psychosis Intervention Service • Provides a service to adults between 18 & 30 • First episode of psychosis within the last 12 months • 3.8 FTE Multidisciplinary team • Service available for up to 3 years • Situated in cottage on hospital grounds

3. Contact with families & the commencement of family education • As soon as is practical • On referral, at initial assessment • If client an in-patient family members will be contacted and met • Usually contact is with parents but may be partner or adult sibling • Psychoeducation plus information pack • (all of above dependent on client’s consent)

4. Routine involvement with families • Invited to EPIS to give full history • Meetings with treating doctor • Meeting with case manager • Contact more frequent in first few weeks or when client relapsing • Many telephone calls between case manager & family

5. Family Education – why do we do it? • Families are the primary carers • Bear most of the burden • Often difficult for families to accept the diagnosis • Psychoeducation destigmatizes MI • Diminishes barriers to treatment • Treatment provides better outcomes

6. Psychoeducation results in fewer relapses and admissions • High levels of expressed emotion detrimental to young person with psychosis • To give hope • Evidenced based

7. A recent quote from a father of a young woman with schizophrenia: “We were devastated when it first happened. we found that the information we gained, mainly from the Family Education Programme, helped us deal with the problems and move forward”.

8. Family coping strategies & beliefs • All will be resolved by studying • It’s just depression • Alternative remedies will fix it • It’s the drugs that caused it • It’s their fault for not studying • It’s their diet • He/she just needs a job • It happened because I worked when he was little

9. Family Education • A five week programme for adult family members of young person attending EPIS • The main aim is to promote recovery by providing information about psychosis (generally people are poorly informed) • Is interactive • Allows participants to ask questions • Gives participants the opportunity to interact with each other

10. Helps alleviate guilt & blame • Allow emotional discharge through exchange of experiences with others • Exchange of experiences aids the healing process • Supports treatment • Assists in the recognition of relapse or crisis • Packs of fact sheets for all topics covered handed out

11. 7 until 9pm • Two facilitators plus other speakers for 4 of the 5 sessions • Break half way through • Enables families to talk to each other • Between 6 & 20 people attend • Mostly parents but also may include adult siblings, grandparents, partners & friends. • Good attendance rates • Run three to four times a year

12. Week One – Course Introduction • Introduction to the course, facilitators & participants • Information about EPIS & the wider service given • Goals of EPIS discussed • Inform about what EPIS can & can’t do • DVD shown about psychosis (10mins)

13. Week Two – “What is Psychosis?” • Attended by consultant or registrar • DVD shown • Topics covered include: • The meaning of the word ‘psychosis’ • Symptoms of psychosis • Causes • Genetics • Different psychotic illnesses

14. Stress Vulnerability model • Co-morbid conditions, depression, anxiety, O.C.D. etc • What to look for – signs & symptoms of relapse • Behaviour versus illness • The future for the young person • Stages of the illness

15. Week Three – Medication & other treatments • Presented by consultant or registrar • Topics include: • Different medications used (Psychosis & other disorders) • Side effects (short & long-term) • How they work • How long they may be needed • Ceasing, reducing, increasing and switching • Impact on functioning

16. Psychological interventions explained • Counseling • CBT • Promotion of healthy lifestyle • Social activities

17. Week Four – Drugs, Alcohol and Gambling • Presented by Hornsby DAG Counselor • Topics covered: • Drug use & abuse - Illicit & prescribed drugs • What’s out there • What they look like • Cost • Signs & symptoms of use & withdrawal • Link between psychosis & drugs • How to respond to the problem • Interactions between prescribed medications illicit drugs and or alcohol • Who to contact

18. Week Five • Recovery & the Future • A Carer’s story – presented by a parent • The experiences of a consumer – presented by a consumer

19. The Mental Health ActPresented by Accredited Person Topics include: • Outline of Mental Health Act (brief history & purpose) • Involuntary admission • How the Act applies to in-patients • Community treatment orders • Concerns about disclosure of mental illness • Concerns about who has access to information • Consumer/carer rights

20. Client involvement • EPIS clients are not invited to the Family Education Programme • Why not? • Their absence enables family members to be open and to ventilate their distress and talk about their experiences • Clients can find discussion about their symptoms embarrassing

21. Clients may have varying degrees of difficulty with concentration, depending on their wellness • Psychoeducation is provided to clients on an individual basis or with their family

22. Family Support Group • Meets monthly throughout the year • Aim is for parents to meet & support each other and is also educational • Ask questions of the facilitators • Some never miss a meeting • Others comes when they feel the need • Sessions have guest speaker on alternate months

23. Tribetime • Meets three times a year • In the evening • Staff, clients & families attend • Local external venue • Aim is for families to meet socially and for clients to meet each other • Good attendance • Last meeting is for Christmas