Transcriber: Daniel Enger Reviewer: Tanya Cushman
So as psychologists and counselors, we spend quite a lot of time and energy
trying to create spaces that are open and accepting and safe.
Now, that doesn't keep people from feeling really apprehensive to visit our spaces
to share examples of challenge and distress.
This is especially true for individuals experiencing psychotic illnesses
like schizophrenia,
and in particular,
young people who are experiencing psychotic symptoms for the first time.
At best, psychotic systems are confusing.
And at worst, they are terrifying.
So for a young person,
coming into the office of someone that you don't know
and describing that you're hearing voices saying nasty things about you
or telling you to hurt yourself,
or explaining that the FBI is following you
or that your parents are poisoning your food -
this can feel really threatening.
By the time young people do get to the office
of myself or other colleagues who specialize in this area,
I feel confident that we can be really helpful.
There are gold-standard treatments for psychosis that work.
They're effective: young people get better.
But that's just it.
Getting to our offices is not easy.
A confusing mental health system,
stigma, fear,
these all create barriers to be scaled,
in addition to the experiences that these young people are having.
By the time folks do get to my office,
they've often been through a really harrowing journey.
They've experienced a traumatic psychiatric hospitalization.
They've seen multiple doctors and tried multiple treatments
while they try to figure out what's going on.
Or they've suffered through a persistent psychotic episode without treatment
while they hope it will get better on its own
and they and their families pray that it's not what they think it is.
Now, there's a critical time, a critical window,
after the onset of the first symptoms of psychosis
where we want to initiate treatment as early as possible
for the greatest impact.
It's during this time that we need a lot of help
because that window that's so critical, that can take months.
It takes way too long for young people experiencing psychosis
to get connected to early and effective treatment.
And that's what a lot of my work has been focused on -
trying to hasten, ease that process of getting connected to treatment.
I know that there are people in the lives of young people
that could assist us in this,
and I want to talk to you about these perfectly placed candidates
that we'd like to recruit to join our mental health community.
Before I talk to you about these individuals,
I want to share more about psychosis
so you have a better understanding of these experiences.
Now, most of us are aware of the reputation of psychosis,
from news and media.
In reality, psychosis is characterized
by false sensory experiences, or hallucinations;
false belief systems, or delusions;
a limited experience of things like motivation and pleasure;
disorganized thinking and behavior;
and cognitive impairments.
Psychosis is found in every culture around the world,
and there's often a genetic component.
The typical age of onset for psychosis is 16 to 24.
So if you're sitting here thinking,
"That's a really busy time; a lot of other things are happening,"
you're right.
Young people are trying to figure out who they are, who they want to be.
They're forming really strong friendships, and they're planning for their futures.
You can think of a psychotic episode like a traumatic brain injury.
It is very disruptive to many of the brain's core processes:
communication,
regulation of mood and behavior,
reality testing,
problem solving,
decision making.
So these disruptions occurring during this critical time in development,
they have significant implications for the future of a young person
in this situation.
The longer a psychotic episode persists without treatment,
the longer and more arduous the recovery.
And yes, I did say recovery.
There is recovery from these experiences.
What's challenging about these experiences for young people is the consequences.
The consequences of untreated psychotic illness are severe.
People often have an increased number of psychiatric hospitalizations.
They're more likely to have medical comorbidities,
like heart disease and diabetes.
They're more likely to have involvements with the legal system,
drug use and homelessness.
Because of these things, young people often have to disengage
from work and school and their friendships.
The evidence for treatment is fortunately robust.
Young people get better.
With early, effective treatment, they return to work and school.
They reengage in their relationships.
They make plans for the future, and they achieve them.
And I know because I've seen it, and it's really, really incredible.
So the aim is to initiate treatment in the earliest sign of symptoms
to minimize the impact of a psychotic episode.
You may remember me telling you a moment ago
that recovery is real and young people get better.
You might also remember me telling you
that getting connected to effective treatment is a real challenge.
And hopefully, you'll remember me telling you
about these perfectly placed candidates who really can assist us.
While psychosis shows up during a really vulnerable time in development,
this stage is also rich in its potential for recovery
because young people are plugged into systems
in really consistent and predictable ways.
They're at school every day.
They're at work in the evenings.
They're at soccer practice or theater practice in the afternoons.
They're at synagogue on Friday or church on Sunday.
And they're at their friends' houses everywhere in between.
This is huge for early intervention
because what that means
is young people are embedded in systems where they can be observed over time.
There are people who are present who can notice shifts that occur.
They can notice if these shifts appear to be maintaining
compared to these random fluctuations that happen in adolescence
that we've all experienced in here.
And they can notice if these shifts that appear to be maintaining
are also causing problems or causing distress.
The people that are embedded in these systems
are who my colleague, Dr. Carina Iati, and I like to call "first responders."
This term is typically reserved for our emergency medical professionals,
but the folks that I want to talk to you more about
because of their role and responsibility in the lives of young people,
all are likely to be on the front lines of an emergency - a psychiatric emergency.
With the right tools, these individuals could really help us and assist us
in identifying the earliest signs of psychiatric and psychotic illness.
These folks are also unique
in that they're more likely to have
established relationships with young people
and already been seen as helpers in some sense.
Who are these first responders?
They're teachers.
They're coaches.
They're faith leaders.
They are community leaders.
They're local law enforcement.
They're parents.
Most of these people don't have any mental health training.
In fact, if you ask them, they would probably say,
"I don't feel comfortable or confident or competent
to assist anyone toward mental health treatment
or to step up during a psychiatric crisis."
Yet these people have such a unique opportunity
to be present when something like this is happening.
They can help us identify early warning signs.
They can lean on their already established relationships
to have tough conversations about concerning symptoms and behaviors,
and they can provide ongoing support.
The overall goal is to create a broader mental health community
where we have more people who are participating -
people who wouldn't think they have anything to offer
to a mental health community
or that this is a community for them,
that they don't have any connection with it.
First responders are a group of people that we really want to add in,
with something important to offer.
Now, I want to tell you how we do this, and there are three important steps.
The first step is shoring up investment and demonstrating the opportunity.
Most of these first responders aren't going to have any idea
of what they have to offer in terms of mental health.
We want to share that information with them.
We also want to let them know about the consequences,
the really significant consequences of delayed or untreated psychosis
for individuals, for families and for communities.
We also want them to be aware of the enormous potential
that comes with recovery.
The hope is that with this information, they will invest even more
in the mental health of the young people that they're already serving.
The second step is to arm these folks with information, education and training.
These early warning signs I've talked about,
we want them to have information about those things -
warning signs about, like, confusing speech,
unusual thinking,
paranoid ideas,
changes in performance, mood or cognition.
We also want them to be aware of the many verbal communication strategies
that are most likely to be helpful
during psychiatric crisis or a psychotic episode.
Things like simple, clear and direct questions and statements,
and nonverbal communication strategies like personal space.
We also want them to be aware of ineffective communication strategies
that aren't likely to be helpful during a psychotic episode,
like challenging hallucinations and delusions,
that what they're experiencing isn't real.
We also want these folks
to know about the variety of approaches they could utilize to assist someone,
based on their comfort level.
There are so many right ways to step up and initiate this,
everything from just sitting and being present and listening
to having a tough conversation,
something like,
"Here's what I'm noticing. Here's why it worries me.
And I think it might be time to ask someone for help."
It's not the responsibility of first responders
to make treatment happen.
We just ask that they invest in the process,
they plant a seed, and they take a step.
It's also not their responsibility
to diagnose;
we're just asking them to observe.
The third step is creating agents of change.
The more people we have involved in our mental health community,
the greater impact that we can have overall for everyone in this community.
The more we're talking about mental health,
the better able we are to destigmatize these kinds of experiences
and normalize the stress and normalize seeking help.
One of our biggest issues in mental health is silence and fear.
When we don't talk about it, we don't do anything about it.
Now, I have no doubt there are many really empathic people here
who are thinking,
"I'm not like a first responder per se, but I would like to do something to help."
Well, that's great - we want to invite you as well.
We want this to be a big community,
beyond just individuals with lived experience
and their family members and their providers, like me.
And there are two things that you can do today
that would be really helpful.
The first thing is arm yourself with information.
You can go to websites like nami.org or [nimh.nih.gov],
where they talk a lot about mental health.
If you want to be more actively involved in the way I've been describing,
you can sign up for mental health first aid,
where you can get training
on how to identify these early warning signs and how to initiate steps for help.
The second thing that you could do, starting today,
and this is very, very important,
and it's something that, as a clinician, I am actively practicing every day,
and that is to choose your words really wisely and carefully.
Language is very powerful, and it's very meaningful,
and we use words like "psychotic," "crazy," "insane" all too often.
We're using these words in situations where we're sending negative messages
about experiences associated with these words.
We can extend this to things like, "Oh my god, I'm so OCD!"
or "Did you see her today? She was so bipolar."
When we use words like that, we're sending messages that say,
"I don't want to be that."
We want to be inclusive with our words, not isolating or ostracizing.
The way we talk about mental health impacts how we treat mental health.
So I want to thank you all in advance for your all's help with that.
In summary, the goal is to create a broader mental health community
where we have more people
invested in and advocating for individuals with lived experience.
We want to do this for everyone - don't get me wrong -
everyone with lived experience we want to be serving and supporting.
But I'm talking about psychosis specifically today
because psychosis really is unique.
It's unique in its reputation,
which impacts how we think about individuals with these illnesses
and how we treat them.
It's also unique in the severity of the consequences of these symptoms
when they go untreated
and the impact they have on young people's lives.
And it's also significant in the size of the potential that there is for recovery.
Psychosis shows up during this really critical time in development,
and it can be really, really disruptive.
There are people that are present during this time
who can assist us in making a difference in how this looks for young people.
With the right tools, these individuals can be active participants
in helping young people seek treatment.
The more people that we have invested and involved
in a broader mental health community overall,
the better able we are to destigmatize mental illnesses,
to dispel myths about mental health
and to demystify illnesses like psychosis.
In turn, and most importantly,
the more people that we have participating,
the better able we are to provide these young people with better access
to the lives that they and their families have been dreaming of.
So thank you.
(Applause)