Arjun’s Story
Arjun’s story highlights the Early Psychosis Intervention Ontario Network (EPION) service.
Student Profile
Arjun is a 22 year student, continuing his second year of university. Arjun lives on-campus in residence, is in good academic standing and actively participates in campus activities.
Presenting Concern
Arjun is experiencing anxiety and suspiciousness (Prodromal phase of psychosis) and has withdrawn from friends and activities on campus. Arjun uses marijuana on a regular basis to reduce his symptoms.
Background Story
Arjun is a 22 year student who experienced a first episode of psychosis while in his second year at university. His residence don noticed he was staying in his room more than usual, missing classes, no longer joining campus activities, and expressing suspicious thoughts. As a result, the don encouraged Arjun to go to Student Health Services (SHS). Arjun and his don went to SHS together and Arjun provided written consent that the don could provide collateral information to SHS. Student Health Services provided Arjun with assessment and counselling. During the assessment, Arjun talked about using marijuana to help him feeling more relaxed.
Arjun returned to class and residence living with periodic support through Student Health Services. However, Arjun continued to experience paranoia and anxiety and decided to leave school and move back home with his parents. Arjun’s symptoms continued to occur at home and his parents brought him to their family physician. The physician assessed Arjun and referred him to the local Early Psychosis Intervention (EPI) program. The EPI clinic confirmed that Arjun was in an acute phase of psychosis and was experiencing paranoia and auditory hallucinations.
While in the EPI service Arjun received antipsychotic medication treatment and metabolic monitoring for the effects of the antipsychotic medication. He also received various psychosocial supports and psychotherapeutic interventions. Arjun received education regarding the impact of cannabis on psychosis and attended a concurrent disorders group at the EPI service. With the assistance of his EPI care coordinator, Arjun applied for a medical withdraw from the term that he left prematurely. Arjun signed a consent form (see Sample Consent Form) for the EPI care coordinator to communicate with the Accessibility Learning Services (ALS) at his university to arrange for this medical withdraw.
By the start of the following academic year, Arjun’s symptoms had primarily stabilized. Arjun wanted to return to university and his EPI care coordinator helped him complete his residence application and the request for residence accommodations. The care coordinator also encouraged Arjun set-up an appointment with ALS prior to school. With Arjun’s verbal and written consent, his care coordinator attended the initial meeting with Arjun and his ALS counsellor. The ALS counsellor developed an accommodations plan for Arjun and met with him on a regular basis to ensure that the identified accommodations were being successfully implemented. The ALS counsellor also connected Arjun with a peer buddy to help with the transition back to school life.
During this transition back to school, Arjun’s parents wanted the opportunity to know how he was doing academically and with the ALS and other on-campus supports. Arjun and his ALS counsellor agree that parental support would be helpful. ALS obtained Arjun’s written consent to share information with his parents, recognizing that they too are part of his circle of care (see Sample Accessibility Learning Service Letter).
First Point of Contact
Arjun’s residence don noticed his change in mood, thoughts and behavior and encouraged him to seek on-campus support at Student Health Services (SHS).
Carepath
Treatment Plan
Arjun will continue to meet regularly with his EPI care coordinator for counselling, support and intensive case management. Arjun will meet with Accessibility Learning Services on an as needed basis. ALS will continue provide Arjun with accommodation recommendations based on his abilities; and advocate for these accommodations in classes. EPI, ALS and Arjun will meet together on-campus, as needed, to ensure Arjun continues to receive coordinated care and appropriate services, supports and accommodations. Arjun will connect with his Peer Buddy to assist with the transition back to school.
Campus-Community Partnerships
Early Psychosis Intervention (EPI) program and the University’s Accessibility Learning Services
- Student Health Services and the Early Psychosis Intervention (EPI) program should have connected initially.
Key Considerations
- Increase awareness and partnerships between campus services and Early Psychosis Intervention (EPI) programs
- Increase awareness of early psychosis symptoms amongst campus frontline service providers to enhance early identification and referral.
- EPI programs can provide extensive services reducing the workload for campus service providers while effectively supporting the student. For example, EPI services assisted Arjun with returning to school, academic accommodations, residence accommodations, referrals to on-campus supports and intensive case management.
- Often EPI clinicians are not aware of the specific academic accommodations available at a particular campus; however they will likely know the cognitive and functional limitations of a client – therefore having a collaborative conversation between the EPI clinician and the ALS counsellor to determine the indicated and available academic accommodations is ideal.
- Some EPI services have access to neuropsychological testing services and therefore some students may come to ALS with this report being completed and therefore possible recommendations – this report can be provided once Arjun signs a release of information form for EPI and ALS to share his information.
- It would be of value for the ALS to have regularly scheduled meetings with the client/student to check in and assess how the accommodations are working at school – this can be a useful proactive measure
- Consent: encourage the student to sign a consent form/release of information form which will allow the treatment team/circle of care to communicate and share information that will help support Arjun in his recovery.
- With the student’s consent, have the EPI team periodically participate in the on-campus appointments with the individual
- The EPI team likely does not have a full understanding of all the available on-campus supports, therefore having regular conversations with the treatment team is valuable
- Collaboration is key – it is the best way to ensure that a student’s/client’s needs are best met – the EPI team WANTS to collaborate
- EPI services can be accessed and initiated by various referral sources – including on-campus supports; go to http://epion.ca/looking-for-help/where-to-get-help for the contact information for every EPI service that covers every geographic area of the province
- EPI services can be contacted for consultation or to assess if a student is appropriate for their services – if the on-campus supports are not sure
- Substances can play a role in the triggering of a psychotic episode and/or the exacerbation of symptoms
- With the student’s consent; the family can be part of the circle of care; however not all students want their family involved. EPI services are family sensitive and work with the client to include the family in their recovery; sometimes family support can be helpful to assist with the follow through of treatment recommendations. often EPI services have a family support worker as part of their team or have access to family support services.
Additional Information
EPI Objectives
- Minimize the duration of untreated psychosis (DUP) – improves outcomes and treatment resistance
- Minimize disruption of roles and responsibilities, relationships, and social skill
- Minimize substance use and other co-morbidities
- Minimize safety risks & hospitalizations
Key Elements of an EPI Program (MOHLTC)
- Early identification, facilitating access
- Comprehensive assessment
- Treatment – intensive follow up; appropriate and individualized treatment (medical – diagnostic assessment, medication assessment, metabolic interventions; and case management – see psychosocial support)
- Psychosocial support (coping strategies, life skills, independent living skills, educational/academic, vocational/employment, housing, social/recreational, peer support)
- Family education and support
- Normalized recovery context
- Education and research