How to refer someone to the Nova Scotia Early Psychosis Program

From the Nova Scotia Early Psychosis Program (NSEPP) website:

Because NSEPP is located in Halifax, within the largest of the Nova Scotia health regions; Capital Health, the program provides direct clinical services to residents of the Capital Health district.

Referrals to NSEPP can be made by anyone, including mental health care professionals, family physicians, community agencies, educators and school counselors, family members, friends and any young person who suspects they may be suffering from a first episode of psychosis.

Criteria for referral of individuals who reside in the Capital Health district are:

• Any individual between the ages of 15-35 who is suspected of experiencing or has been diagnosed with a first episode of psychosis, and

• Has been treated for less than 6 months with an anti-psychotic medication, and

• At the time of referral has had active, untreated psychosis for less than one year.

If you or someone you know meets these criteria please contact the NSEPP immediately at (902) 473-2976.

What can I expect if I refer someone who resides in the Capital Health district?

• The intake coordinator from NSEPP will usually contact the person making the referral within 1- 2 working days after NSEPP receives the referral. The purpose of this contact is to obtain information necessary to decide if the person being referred meets the criteria for the NSEPP program and to also determine the urgency of the referral.

• All information regarding new referrals is presented by the intake coordinator to the NSEPP multidisciplinary team at their weekly meeting. At that meeting the NSEPP team will determine if the individual referred meets the criteria for the NSEPP program. If a referral meets criteria, NSEPP endeavours to assess those individuals within 1-2 weeks.

• Priority for appointments for initial assessments will be determined by the NSEPP team based on their assessment of the degree of urgency.

• Urgent referrals are assessed, whenever possible, within 1-2 working days.

• The individual making the referral to the NSEPP will be notified of the date of the assessment appointment and, after the assessment is completed, will be notified of the outcome.

• If it is determined that an individual referred to NSEPP does not meet criteria for the program, the individual making the referral will be notified by the intake coordinator and will be provided with information regarding referral to other appropriate mental health services. 

Under the provincial service delivery model developed by the Nova Scotia Department of Health and as one of the Dalhousie University Department of Psychiatry clinical academic programs, NSEPP provides clinical consultation for residents of the Maritime provinces who reside outside the Capital Health district.

Criteria for referral of individuals who reside in the Maritime Provinces outside of the Capital Health district:

• NSEPP only accepts referrals for consultation from health care professionals including any mental health care professional or family physician, and

• Any individual between the age of 15-35 who is experiencing early psychosis (within the first 5 years of the onset of psychosis), may be referred for a consultation regarding diagnosis and/or treatment.

NSEPP does not provide ongoing clinical services to individuals who reside outside of the Capital Health district.

What can I expect if I refer an individual who resides in the Maritime Provinces outside of the Capital Health district?

• The intake coordinator from NSEPP will usually contact the person making the referral within 1 week after NSEPP receives the referral. The purpose of this contact is to obtain more detailed information regarding the reasons for the referral for consultation from the NSEPP.

• All information regarding consultations is presented by the intake coordinator to the NSEPP multidisciplinary team at their weekly meeting. At that meeting the NSEPP team will determine if the consultation referral to NSEPP meets the program criteria for consultation from NSEPP.

• If a consultation referral meets the NSEPP criteria, the NSEPP endeavours to assess all individuals referred for a consultation within 4 weeks after NSEPP receives the referral

• The individual making the referral to the NSEPP will be notified of the date of the consultation appointment. Once the consultation is completed, the individual making the referral will receive a written report.

• If it is determined that an individual referred to NSEPP does not meet criteria for referral for a consultation from NSEPP the individual making the referral will be notified by the intake coordinator and will be provided with information regarding referral to other appropriate mental health services.

At this time, persons referred for a consultation with the NSEPP must be willing to travel to Halifax/Dartmouth Nova Scotia for an assessment

To make a referral for a consultation please contact (902) 473-2976.

Image credit

Also see:

Nova Scotia Early Psychosis Program - Brochure

Nova Scotia Early Psychosis Program - Website

Nova Scotia Early Psychosis Program - Family Education (PDF)

Mending Minds

Key Findings in Early Psychosis: A Knowledge Sharing Initiative

Please click on the image to magnify it.

To download a PDF version of the above flyer, please click here.

To join the initiative, or for further information, please send an email to keyfindingsinearlypsychosis@outlook.com.

Also see:

Key Findings in Early Psychosis - Facebook Page & Twitter

Video Introduction to Key Findings in Early Psychosis Knowledge Sharing Initiative

Nova Scotia Early Psychosis Program

Schizophrenia is not a progressive brain disease

A December 4, 2012, posting by the Nova Scotia Early Psychosis Program:

Young people who experience a first episode of psychosis often receive a diagnosis of schizophrenia.

Historically there has been the view that schizophrenia is a progressive, deteriorating condition and many clinicians were taught that point of view in their training.

When the field of Early Psychosis began to develop in the 1990s, a major theme was to discard the pessimistic attitude that clinicians held toward the possibility of significant recovery in psychotic disorders and replace it with a more balanced positive approach. The specialized Early Psychosis services that are now widely available are based on this attitude of realistic optimism.

As well, people with lived experience of psychosis, and their families, have increasingly insisted and demonstrated that recovery in schizophrenia is a realistic and attainable goal.

Yet studies of brain structure and function continue to produce data suggesting that there may be progressive changes associated with a diagnosis of schizophrenia.

In an article published in the Schizophrenia Bulletin journal in November 2012, Dr. Robert Zipursky (pictured) a leader in psychosis reseach in Canada, along with eminent colleagues in the UK, reviews the current evidence related to the question of whether or not a diagnosis of Schizophrenia indicates the person has a progress brain disease.

The article reviews all the recent evidence from brain scans, as well as other sources of data, and concludes that “schizophrenia is not a malignant disease that inevitably deteriorates over time, but one from which most people can achieve a significant degree of recovery”.

The authors strongly urge clinicians to provide young people and their families with this up-to-date information so that the old myths regarding negative outcomes for people receiving a diagnosis of schizophrenia can be laid to rest.

For a free copy of the full article click here.

Dr. Zenovia Ursuliak speaks about the Nova Scotia Early Psychosis Program

To view this YouTube video, please click here.

Laura Burke named a 2010 Champion of Mental Health

From the 2010 Mental Illness Awareness Week website:

Champion - Youth

Laura Burke
Concordia University, Master's in Drama Therapy student



Ms. Burke [pictured above] has made outstanding contributions to the field of mental health in Canada, working to raise awareness, fight biases and stigma, and contribute to community organizations. She has given talks on recovery for the Nova Scotia Early Psychosis Program and acted as a peer support worker at Laing House, a drop-in centre for youth living with mental illness. When at Laing, she also ran a drama group and a writer’s circle, and was constantly inspired by the courage, resilience and determination of the youth she worked with.

In 2008 she recorded an album of her spoken word poetry about her journey through schizophrenia and recovery, and in 2009, she began her role at the Schizophrenia Society of Nova Scotia as a peer support facilitator. Ms. Burke has showed continued dedication to the field of mental health, and has bravely drawn on her own experience with schizophrenia to positively impact her community.

Ms. Burke strongly believes that social inclusion, unconditional acceptance, and the opportunity to use creativity as a force of healing are invaluable, too often overlooked components of recovery. After graduation, Ms. Burke hopes to research and practice drama therapy to improve negative and cognitive symptoms in youth experiencing first episode psychosis.

Also see:

2010 Mental Illness Awareness Week (October 3rd to 9th)

2010 Champions of Mental Health

About the Champions of Mental Health Awards

Superhero - A Visual Poem

Scientists try to stop schizophrenia in its tracks

An article posted on July 26th by ABC News:

Seeking to block voices, 'odd thoughts,' scientists try to stop schizophrenia in young people

By Malcolm Ritter, Associated Press

PORTLAND, Maine — She was sociable and happy in high school. But in college that changed abruptly: Depressed and withdrawn, some days she couldn't get out of bed.

And that wasn't all.

"I had really odd thoughts," recalled the woman, now 21, who asked that her name not be used. While walking across campus at the University of Southern Maine, "sometimes I'd feel like people were just right behind me (who might) jump me or something."

She knew it wasn't true, but she couldn't shake the feeling.

Sometimes, while driving, she saw imaginary, shadowy people on the sidewalk. And now and then, out of nowhere, there would be a woman's voice in her ear during class, or random soft noises like knocking or the fizzy hiss of a newly opened soda can.

When she visited the university health service and talked about feeling depressed, a nurse practitioner saw another problem: a possible case of schizophrenia in the making.

This schizophrenia "prodrome" — the early signs — involves a troubled mental state usually found in teens and young adults. It can lead to psychosis, the loss of touch with reality that marks not only schizophrenia, but also some forms of depression or manic-depression. The prodrome can linger for weeks, or years, before it gives way to psychosis — or mysteriously disappears without a trace.

Researchers have known about this warning phase for decades, but they're still working on how to treat it. Now they're calling in tools like brain scans, DNA studies and hormone research to dig into its biology. They hope that will reveal new ways to detect who's on the road to psychosis and to stop that progression.

In the prodrome, people can see and hear imaginary things or have odd thoughts. But significantly, they understand these experiences are just illusions, or they have a reasonable explanation.

In contrast, people with psychosis firmly cling to unreasonable explanations instead. When someone interprets an odd halo of light over a bedroom doorway as an urgent message from a dead relative, "that's when they have gone over to the psychotic side," said Dr. Thomas McGlashan, a Yale University psychiatry professor.

Some early signs of the prodrome are subtle. "Sometimes kids will (say) light seems different," and windows are too bright, said Ann Lovegren Conley, the family nurse practitioner at USM who spotted apparent prodromal symptoms in the student on her campus.

That can signal "this is not just typical depression or situational stress," Conley said. "There's something more here."

After hearing the student's story, Conley put her in touch with the Portland Identification and Early Referral program, called PIER, one of about 20 clinics in the United States that focus on treating prodrome cases. PIER has trained her and thousands of other school nurses and counselors, pediatricians and others in greater Portland in how to spot them.

PIER emphasizes non-drug therapies for its patients, ages 12 to 25, although about three-quarters of them take anti-psychotic medication.

The treatment regimen includes group meetings in which patients and families brainstorm about handling the condition's day-to-day stresses. It also focuses on keeping patients in school and in touch with their families and social networks.

With a grant from the Robert Wood Johnson Foundation, the PIER approach is also being tried in California, Oregon, Michigan and New York.

Even before treatment begins, a patient's encounter with someone who understands can be dramatic. McGlashan recalled that one young woman at the Yale clinic burst into tears when being asked about symptoms, explaining, "I thought I was the only person in the world who was having these experiences."

Or, when asked if they've felt like the television was speaking to them personally, young clients may reply, "How did you know?" McGlashan said.

Studying the schizophrenia prodrome has been tough for the small but growing group of researchers in the area, because the condition is relatively uncommon. A typical community may get only one new case per 10,000 people each year,* and only a fraction of those people would end up in a research study.

A federally funded project kicked into gear this year to uncover biological signals that will help identify people headed toward psychosis. There's already early evidence, for example, that combining brain scans with a standardized interview can greatly help, said Tyrone Cannon of the University of California, Los Angeles.

Such research should also point the way to better treatments, by exposing the biological roots of psychosis, Cannon said. He's the principal investigator of the project, which is being carried out at several medical centers.

When it comes to treating the prodrome, scientists say they have some promising approaches but no firmly proven treatments to prevent psychosis from appearing.

Low doses of anti-psychotic drugs dampen symptoms. But it's not clear whether those drugs can actually prevent psychosis. Side effects like serious weight gain are a problem, especially since many treated patients would never have developed psychosis anyway. What's more, the weight gain can turn young people away from anti-psychotic drugs, even if they move on to become psychotic and clearly need them.

Researchers are finding promise in psychosocial treatments, like those aimed at helping patients learn to manage stresses in their lives or understand and interpret their symptoms. Efforts to help young people complete their education, hold a job and stay connected to peers will help them avoid unemployment and social isolation later on, whether they progress to psychosis or not, experts say.

In fact, keeping up social contacts may help manage the prodrome. "We're convinced that if they start closeting themselves, coming home after school and just spending time in their bedroom, that will accelerate any process toward psychosis," McGlashan said. "If you dim your social life, it makes it easier for your brain to hallucinate and develop strange ideas."

The PIER program, which began eight years ago, hasn't yet published detailed results on its effectiveness. Its goal is to cut the rate of hospitalizations for first episodes of psychosis in Portland. Dr. William McFarlane, who directs it, says early analyses of the results look promising but that it's too early to draw conclusions.

And results from other locations trying the PIER approach won't be available for a couple of years, says Jane Lowe of the sponsoring Johnson foundation.

Still, in Portland, McFarlane said, "we see kids getting better every day."

One of them was the college student Conley referred. With the help of individual counseling, antidepressants and an anti-schizophrenia drug, "gradually I opened up to people," the young woman said.

She started playing tennis, joined a sorority and began exercising in the school gym. She wasn't sad all the time any more. And she stopped hearing and seeing things that weren't there.

On the Net:

• PIER and similar programs: www.preventmentalillness.org

* This statistic represents 94 people per year in Nova Scotia; not an insignificant number, particularly as it relates to the individuals, families, friends, and coworkers who are affected.

Living Healthy in Atlantic Canada

A new magazine published by the QEII Foundation contains an article on the Nova Scotia Early Psychosis Program. The article, entitled Mending Minds, appears on pages 28 to 31 and can be accessed by clicking here (downloads a large PDF).

For a hard copy of Living Healthy in Atlantic Canada, send an email to fndnew@qe2-hsc.ns.ca with your mailing address. (Note: The QEII Foundation provided an incorrect email address. The correct email address was posted here on April 5th. Thanks to Valarie R. for pointing this error out to me.)

What We Know ... What We Don't Know About Schizophrenia

A very informative posting on the Schizophrenia Research Forum website. To view, click here.

Thanks go to the Nova Scotia Early Psychosis Program for pointing this website out to me.

New Location for the Nova Scotia Early Psychosis Program (NSEPP)

A September 30th email received by the SSNS from the Nova Scotia Early Psychosis Program:

We are very pleased to advise you that in October, the Nova Scotia Early Psychosis Program will move to our new location on the 3rd and 4th floors of Abbie J. Lane Building at the Halifax Infirmary. The program offices will be closed on October 10, 11, 12 and 15 for the move and beginning Tuesday, October 16, 2007, our clinic will be re-opened at this new location.

This move was expected as part of the restructuring plan for the CDHA Mental Health Program. However, due to the declining condition of Simpson Hall, the strategic process for NSEPP to move was pushed forward earlier than anticipated.

The NSEPP will re-locate with all of its staff and programs with "business as usual". Our referral intake procedures remain the same as will the list of educational programs we offer to our patients and families.

Our work to provide clinical care, research and education to our early psychosis patients will continue to expand as new opportunities for collaboration with other mental health programs and community partners will be available. Our new location will also make it easier for us to be closer and to connect with the acute care services projected with the expansion of the emergency department at the Halifax Infirmary.

If you have any questions, please contact us at earlypsychosis@cdha.nshealth.ca or visit our website at www.e-earlypsychosis.ca. Until October 9, you can call 464-5997 but effective October 16, you can reach us at our new phone number 473-2976.

We will be having an open house at our new location in the Fall so we hope to see you there!