'Ko tenei te wa: navigating the maze of life'

I am delighted to be able to return to the Early Intervention in Psychosis National Training Forum; and I am grateful to the Wellington Early Intervention Service for your invitation.

It is eight years since I opened the wananga, hosted by Ngati Porou in December 2001; and I will be interested to learn what has changed; what has remained the same; and where the challenges lie.

I would expect that one important theme would remain the same - that early intervention in psychosis is a fundamental cause for hope.

It is the hope that the earlier that psychosis is identified and treated, the better the outcomes will be.  Early support to a person and their family, with the right treatment early on, offers much less likelihood of enduring illness or loss of function.

It is the hope that early intervention helps a person and their family to manage that first pivotal episode and to then focus on relapse prevention.

And it is the hope, that all of us can work together, clinicians, health promoters, whanau, community advocates, tangata whaiora; to achieve the best outcomes in a situation of uncertainty.

As I was thinking about this conference, I came across the poem by John Milton, which includes the incredible phrase:

"The melting voice through mazes running

Untwisting all the chains that tie

The hidden soul of harmony".

It was a phrase that made a lot of sense to me in the context of early psychosis. 

Who can tell what that melting voice is to any of us? 

It may be the voice of our tupuna; the voice of our conscience; our inner voice of reason, of identity; of clarity.

But find it we must - to find that strong voice that helps us through the mazes of life; that untwists the knots and restores our full recovery.

You will all be familiar with the Mental Health Commission's Blueprint for Mental Health Services which tells us that recovery is a  journey as much as a destination.   The Blueprint describes this in the following way:

"For some people with mental illness recovery is a road they travel on once or twice, to a destination that is relatively easy to find. 

 

For others recovery is more like a maze with an elusive destination, a maze that takes a lifetime to navigate".

So what we are all gathered here today and tomorrow for, is to find the ways in which we navigate through mazes; to protect the essence of who we are; to restore the connections that bind.

The key to success in early intervention is all to do with the timing.   Early recognition is vital; to be then followed with timely and appropriate support and treatment.

If the first episode is treated well, there is a far higher chance of a successful recovery.

The critical success factors for early intervention are that the very first indications of concern by an individual and whanau are responded to by a team which works in harmony with each other.

That team approach must be one owned and shared by consumers and tangata whaiora, their carers, whanau and clinicians. 

The team might include psychiatric nurses, social workers, occupational therapists, clinicians; but it will also vitally include whanau; friends; peer support workers - young people who may have had similar experiences and who are just as committed to achieve the best possible outcomes for young people experiencing psychosis.

The key is on timeliness; cooperation and collaboration; and every effort made to consider the fullest range of options and opportunities before any treatment plan is agreed to, if at all.

I am always very wary of any interventions which rely, too quickly, on medication as a response. 

Tangata whaiora must be armed with the knowledge to make informed decisions about the use of medication - and the follow through with a plan to monitor the effects.

The theme for this event is ‘Ko tenei te wa - this is the time'.

This is the time, not to immediately problem solve or diagnose with the instant cure.  This is the time to say to each and every one of the families who come through the door - this is your time.

This is your time to share the journey to this point in time now.  What were the triggers that brought you to this service?  Are there recurrent warnings, ongoing tensions that have provoked this episode? 

What are the experiences that may have exacerbated the stress - are there factors such as substance abuse, inherited conditions, mood disorders, which add to the story?

What are the environmental factors that may have influenced your health and wellbeing; or have a negative impact personally and on your whanau?

Engaging early, and intervening well, means those who can take us down as many different roads on the journey as possible, help to put together a road map which guides everyone forward.

Yesterday, the pre-conference workshop led by Dr Warrick Brewer, was entitled, "something is not quite right".  It is a phrase which I would hope all of our families could include within their repertoire of wellness - to care for each other, and to act, not just in knowing when something is not quite right, but in knowing what to do.

The ‘what to do' might mean a trip to the early intervention service is the very first action a family takes.

That makes it so utterly important that the family has a strong entrance point through primary healthcare, to be able to access the right service to lead to recovery.

To be able to offer gold standard diagnosis and treatment you need to get it right from the start.  The gold standard starts in our whanau and our families recognizing something is not right; and seeking help.

When they walk through the doors of the service, they aren't greeted with an admission card, and a category which labels them as having a major diagnosis.

The time is taken to get to know all of the relevant people, to link with primary care, to invest in understanding the important relationships.

There is time to walk with the person themselves - to achieve a stronger understanding about illnesses; to destigmatise and debunk all of the myths that might make it hard to know what is going on.

I want to really congratulate this sector, for your commitment to ensure that family and whanau are essential to recovery. 

The leadership that you have demonstrated in resources such as the Family Matters DVD is extremely important.  It is great that families are not only being supported to understand psychosis, but that you as professionals are learning more about the important role that families play in effective treatment and coping strategies.

If families are onboard, and intervention is as early as possible, then the more likely that there will be positive outcomes.

The benefits of early intervention are immense.  There are reduced risks of hospitalization, of relapse, of disrupted relationships.   We know that recurrent relapses are damaging for a person's future, and bring with them a greater risk of long term morbidity.

So I return again to the challenge - ko tenei te wa - now is the time for harmony.

All of the best practice information tells us that breaking down the silos and offering a flexible approach to service provision is the key to success in providing a comprehensive and holistic approach - an approach which leads to whanau ora.

We need to include the greater whanau in our treatment and recovery plans. 

We need to be confident we have the fullest information possible before heading to a diagnosis.

We want to see integrated service provision - across the health sector, but also across social services, justice, housing and education.

Having support people within your team who are linked into education and employment opportunities, helps to link tangata whaiora back into their communities.   

The transition to employment can be a vital step towards recovery.  In this light, I will be keen to hear from you what impacts the recent decision, withdrawing vocational and employment support from people on sickness and invalids benefits, will have for the people accessing early intervention services.

We want access to excellent clinical treatment but we also want to support families to be confident to manage an episode and to know about relapse prevention.

And most important of all, if we are really committed to the young people we are working with, we must listen to their experiences and we must be willing to learn with them, from them, about them.

Ko tenei te wa - now is the time to listen for the voice through mazes running; now is the time for harmony to prevail.

Your job is to help make it happen.  

I wish you great insights and great courage, in sharing together over these two days, strategies and experiences that will help make all who journey with you travel safely on the road to wellness and wellbeing.