15 Sep 2007, ST
IN MELBOURNE
Here's how the world's most effective clinic does it: Encourage young people to come in; help more, medicate less; perhaps even increase intake of fish oil
AT THIS centre, shocking purple and brilliant green greet you. The garish colours are not most people's idea of a mental facility. But then, Orygen Youth Health in Melbourne, Australia, is not your typical mental health facility.
It is one of the most effective schizophrenia clinics in the world.
The man behind it, Professor Patrick McGorry of Melbourne University, is a passionate believer that early treatment of schizophrenia gives people a chance of a normal life.
He has thought so for 20 years, back when it wasn't a commonly held belief. He managed to convince government and private sector corporations to finance his experimental centre.
Orygen - named for Generation Y - began in 1991 as an early psychosis service, a small outfit with just a handful of doctors.
Today, Orygen is viewed as a cutting-edge mental health centre. Britain and Singapore both adopt its model of early intervention.
It helps 800 new patients a year. Half have what is called a 'social recovery', meaning they can hold down a job or attend school, and have friends, even if some have to remain on medication.
The rest also do better than those treated elsewhere. The key to its success: early identification and aggressive treatment of youth at risk of schizophrenia.
In 1994, Orygen started a mental health clinic specially targeted at young people. Most schizophrenics start showing symptoms in their late teens or early 20s.
To draw in young people, the clinic was set up first at a shopping centre, to 'de-stigmatise' mental illness, said Dr Alison Yung, the psychiatrist in charge of the place.
Today, the clinic has moved to the main Orygen centre which is near both Melbourne and Monash universities. The brightly painted centre caters to all mental health problems among youth such as personality disorders, not just schizophrenia.
'I don't think people feel ashamed of coming here. They talk to their friends about this service.
'It's different from 15 years ago when we had a hospital like Singapore's Woodbridge,' said Prof McGorry, who is one of the external consultants at Singapore's Institute of Mental Health, and who finds Singapore's institutional approach 'bizarre'.
Institutions for mental illness tend to cater to adults and are 'focused on control', Prof McGorry explained. 'It is not geared for teens and young adults in a salvageable situation.'
Staff at the clinic identify youth at high risk of getting schizophrenia - in what doctors call the prodromal phase - and are proactive in trying to prevent the disease from erupting.
Dr Yung has come up with a list of symptoms to look out for. This is derived from extensive interviews with schizophrenia patients on their own early signs and symptoms.
These include: feeling suspicious that other people were out to get them; feeling very self conscious, thinking people are looking at them because they are doing something wrong or look different, and hearing whispers (rather than voices).
Thanks to its proactive approach, Orygen's patients get treated just two months after the first symptoms appear - much lower than the international average of one year.
On average, Orygen patients spent 13 days a year in hospital, against 46 days by non-Orygen patients.
Orygen also boasts a strong applied research unit that has resulted in better outcomes for patients.
It has a research budget of A$8 million (S$10 million) to A$9 million a year and 120 full-time researchers looking into ways to help patients. It also has an annual clinical budget of A$14 million from the state government, and a staff of 140.
Orygen researchers have found that patients will benefit from less medication, since anti-psychotic medicine has side effects.
Long-term use of the older generation of medicines can cause patients to end up with blank-looking faces. Some make involuntary movements like flicking their tongue in and out of their mouth (a symptom referred to as the 'fly-catcher') or repetitively jerking their arms or moving their feet while seated.
Another recent finding that has Prof McGorry excited is the effect fish oil has on preventing psychosis.
A small study in Austria among youth at high risk of getting schizophrenia showed significant protection with fish oil. Eight out of 38 in the control group developed schizophrenia within a year, compared to just one out of 38 in the group taking fish oil.
Prof McGorry will be leading a nine-centre study to verify if the initial findings can stand up to scientific scrutiny. He would love to include Singapore in the study, except doctors here are not yet at the stage where they are picking up prodromal patients, or patients who are at high risk of schizophrenia.
He said: 'If we can show that it's useful, even if it works for only 10 to 20 per cent of patients, we can use it for the whole population as it is such a safe treatment.'
-----------------------------------
IN SINGAPORE
Pilot programme to look out for signs of psychosis
IT USED to be that young people who developed mental problems got into difficulties in school or with the police before ending up in the mental hospital.
These days, the problem signs are more likely to be picked up by teachers and counsellors.
The difference is a pilot programme started by the Institute of Mental Health (IMH) in 2001 to identify early those who show signs of psychosis and treat them.
People with psychosis have a mental illness where they lose touch with reality, becoming, say, suspicious. When it becomes more extreme, it is called schizophrenia.
Under the Early Psychosis Intervention Programme (Epip), hundreds of teachers and counsellors were trained on the symptoms to look out for, such as lack of motivation and apathy or hallucination and delusion.
IMH staff also gave talks to students at universities, polytechnics, junior colleges and institutes of technical studies, and plastered these places with posters of the illness and its symptoms - and the fact that help is at hand.
As a result, teachers, parents and family doctors are able to spot the problem early and get help.
Patients now get spotted about four months after the first symptoms appear - down from an average of one year previously.
So far, 1,100 people have been treated under the programme - without a single one needing long-term hospital care.
The Ministry of Health will expand the programme and gradually raise its funding to $2.5 million a year by 2011.
Once a student with mental problems has been identified, the school can call up a case manager and discuss symptoms.
The student then gets an appointment with an IMH psychiatrist and follows up with treatment. He gets a semester off school to recuperate if necessary.
During that semester off, the student may attend activities like pottery, exercise sessions, social skills training and vocational coaching to keep them active.
Since most are on the verge of entering the job market, they are also taught how to write resumes and do well in interviews.
While schizophrenia cannot be cured, medication can control the symptoms so the patient can continue functioning normally and live in society.
But about 5-10 per cent of patients are drug-resistant and nothing helps. Most of the long-term inmates at IMH suffer from schizophrenia.
Over the years, Epip has become more cost-effective.
In its first year, the disease cost patients $127,602 a year, of which about $4,600 was for medication and treatment and the remaining $123,000 was money lost from not being able to work.
In the second year, the cost fell to $95,856. Money lost from not being to work dropped dramatically to $90,000. The difference is that patients were well enough to return to work.
IMH is also working with the armed forces to identify national servicemen who show early signs of psychosis, since they are at the age when the disease first hits.
IMH research head Associate Professor Chong Siow Ann said the institute is also conducting several large-scale studies on side effects of medication.
Associate Professor Richard Keefe of the Duke University Medical Centre, who works closely with Prof Chong on some of the IMH research projects, said the programmes are 'known throughout the world for its efficiency and patient care'.
IN MELBOURNE
Here's how the world's most effective clinic does it: Encourage young people to come in; help more, medicate less; perhaps even increase intake of fish oil
AT THIS centre, shocking purple and brilliant green greet you. The garish colours are not most people's idea of a mental facility. But then, Orygen Youth Health in Melbourne, Australia, is not your typical mental health facility.
It is one of the most effective schizophrenia clinics in the world.
The man behind it, Professor Patrick McGorry of Melbourne University, is a passionate believer that early treatment of schizophrenia gives people a chance of a normal life.
He has thought so for 20 years, back when it wasn't a commonly held belief. He managed to convince government and private sector corporations to finance his experimental centre.
Orygen - named for Generation Y - began in 1991 as an early psychosis service, a small outfit with just a handful of doctors.
Today, Orygen is viewed as a cutting-edge mental health centre. Britain and Singapore both adopt its model of early intervention.
It helps 800 new patients a year. Half have what is called a 'social recovery', meaning they can hold down a job or attend school, and have friends, even if some have to remain on medication.
The rest also do better than those treated elsewhere. The key to its success: early identification and aggressive treatment of youth at risk of schizophrenia.
In 1994, Orygen started a mental health clinic specially targeted at young people. Most schizophrenics start showing symptoms in their late teens or early 20s.
To draw in young people, the clinic was set up first at a shopping centre, to 'de-stigmatise' mental illness, said Dr Alison Yung, the psychiatrist in charge of the place.
Today, the clinic has moved to the main Orygen centre which is near both Melbourne and Monash universities. The brightly painted centre caters to all mental health problems among youth such as personality disorders, not just schizophrenia.
'I don't think people feel ashamed of coming here. They talk to their friends about this service.
'It's different from 15 years ago when we had a hospital like Singapore's Woodbridge,' said Prof McGorry, who is one of the external consultants at Singapore's Institute of Mental Health, and who finds Singapore's institutional approach 'bizarre'.
Institutions for mental illness tend to cater to adults and are 'focused on control', Prof McGorry explained. 'It is not geared for teens and young adults in a salvageable situation.'
Staff at the clinic identify youth at high risk of getting schizophrenia - in what doctors call the prodromal phase - and are proactive in trying to prevent the disease from erupting.
Dr Yung has come up with a list of symptoms to look out for. This is derived from extensive interviews with schizophrenia patients on their own early signs and symptoms.
These include: feeling suspicious that other people were out to get them; feeling very self conscious, thinking people are looking at them because they are doing something wrong or look different, and hearing whispers (rather than voices).
Thanks to its proactive approach, Orygen's patients get treated just two months after the first symptoms appear - much lower than the international average of one year.
On average, Orygen patients spent 13 days a year in hospital, against 46 days by non-Orygen patients.
Orygen also boasts a strong applied research unit that has resulted in better outcomes for patients.
It has a research budget of A$8 million (S$10 million) to A$9 million a year and 120 full-time researchers looking into ways to help patients. It also has an annual clinical budget of A$14 million from the state government, and a staff of 140.
Orygen researchers have found that patients will benefit from less medication, since anti-psychotic medicine has side effects.
Long-term use of the older generation of medicines can cause patients to end up with blank-looking faces. Some make involuntary movements like flicking their tongue in and out of their mouth (a symptom referred to as the 'fly-catcher') or repetitively jerking their arms or moving their feet while seated.
Another recent finding that has Prof McGorry excited is the effect fish oil has on preventing psychosis.
A small study in Austria among youth at high risk of getting schizophrenia showed significant protection with fish oil. Eight out of 38 in the control group developed schizophrenia within a year, compared to just one out of 38 in the group taking fish oil.
Prof McGorry will be leading a nine-centre study to verify if the initial findings can stand up to scientific scrutiny. He would love to include Singapore in the study, except doctors here are not yet at the stage where they are picking up prodromal patients, or patients who are at high risk of schizophrenia.
He said: 'If we can show that it's useful, even if it works for only 10 to 20 per cent of patients, we can use it for the whole population as it is such a safe treatment.'
-----------------------------------
IN SINGAPORE
Pilot programme to look out for signs of psychosis
IT USED to be that young people who developed mental problems got into difficulties in school or with the police before ending up in the mental hospital.
These days, the problem signs are more likely to be picked up by teachers and counsellors.
The difference is a pilot programme started by the Institute of Mental Health (IMH) in 2001 to identify early those who show signs of psychosis and treat them.
People with psychosis have a mental illness where they lose touch with reality, becoming, say, suspicious. When it becomes more extreme, it is called schizophrenia.
Under the Early Psychosis Intervention Programme (Epip), hundreds of teachers and counsellors were trained on the symptoms to look out for, such as lack of motivation and apathy or hallucination and delusion.
IMH staff also gave talks to students at universities, polytechnics, junior colleges and institutes of technical studies, and plastered these places with posters of the illness and its symptoms - and the fact that help is at hand.
As a result, teachers, parents and family doctors are able to spot the problem early and get help.
Patients now get spotted about four months after the first symptoms appear - down from an average of one year previously.
So far, 1,100 people have been treated under the programme - without a single one needing long-term hospital care.
The Ministry of Health will expand the programme and gradually raise its funding to $2.5 million a year by 2011.
Once a student with mental problems has been identified, the school can call up a case manager and discuss symptoms.
The student then gets an appointment with an IMH psychiatrist and follows up with treatment. He gets a semester off school to recuperate if necessary.
During that semester off, the student may attend activities like pottery, exercise sessions, social skills training and vocational coaching to keep them active.
Since most are on the verge of entering the job market, they are also taught how to write resumes and do well in interviews.
While schizophrenia cannot be cured, medication can control the symptoms so the patient can continue functioning normally and live in society.
But about 5-10 per cent of patients are drug-resistant and nothing helps. Most of the long-term inmates at IMH suffer from schizophrenia.
Over the years, Epip has become more cost-effective.
In its first year, the disease cost patients $127,602 a year, of which about $4,600 was for medication and treatment and the remaining $123,000 was money lost from not being able to work.
In the second year, the cost fell to $95,856. Money lost from not being to work dropped dramatically to $90,000. The difference is that patients were well enough to return to work.
IMH is also working with the armed forces to identify national servicemen who show early signs of psychosis, since they are at the age when the disease first hits.
IMH research head Associate Professor Chong Siow Ann said the institute is also conducting several large-scale studies on side effects of medication.
Associate Professor Richard Keefe of the Duke University Medical Centre, who works closely with Prof Chong on some of the IMH research projects, said the programmes are 'known throughout the world for its efficiency and patient care'.
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