The social approach in adolescents with a first psychotic episode
Although the percentage of people who are treated in the child and youth mental health network with a diagnosis of psychosis is not as high compared to other disorders, the importance of good management of pharmacological and psychological treatment and the impact of the disorder on the person and their immediate environment make interdisciplinary intervention essential from the first detection , with the inclusion of a social work approach.
The aim of the social approach should always be to promote the autonomy and socialisation of the person being treated, as well as to reduce risk behaviours and readmissions. Social support and care for adolescents with this diagnosis and their environment can be provided at any time during the process: emergency department, acute hospitalisation, day hospital or outpatient consultations. However, this intervention often begins in the acute care unit.
Given the confirmation of a psychotic condition, it is necessary to assess the capacities and state of the family or environment (in the case of people under the care of the Administration), bearing in mind that it will involve medium or long-term treatment, the need to take care of the most important habits (structured schedules, taking medication, sleeping hours and avoiding the consumption of toxic substances, among others) and possible adaptations of daily life activities.
At first, the most important thing is to offer comfort to the family and support them in assimilating the situation, understanding the diagnosis and possible grief.
For comfort actions, to calibrate the family's understanding capacities and to offer guidelines for subsequent management, joint interviews can be carried out with other professionals, such as nurses, or with other services. It is always necessary to keep in mind the time required by each person and family (or the residential educational action center, in the case of minors under guardianship) to prepare the information. If necessary, intercultural mediation intervention can also be requested.
Returning to the community after a psychotic episode
In most situations, the passage through the day hospital allows monitoring of the person's return to the community and favoring a gradual recovery of habits -including school-, to avoid tendencies towards isolation when negative symptoms are present. Social work can collaborate in the search for the most appropriate socio-health devices in each case and address the possible difficulties that the person may have in accessing them: finding the most suitable transport, defining the figure of the companion, alleviating extraordinary financial expenses, etc.
In some situations, young people may tell us that they feel ashamed of the delusional behaviors they may have had in front of their friends or schoolmates before admission. If so, it is necessary to address this and work on social skills and coping and resolution strategies before returning to high school or school. Other times, the recovery of training or work activities may be altered by the experience of alterations in memory, comprehension, slowing down or performance. If it is detected, from social work, together with the teaching staff of the hospital classroom and the technical teaching and employment teams of the territory, a specific approach and adaptation can be considered in each case.
How to support students with psychotic disorders
When the adolescent has gained sufficient awareness, it is important to work directly on the recovery of an immediate healthy life project:
- Recovery of friendships.
- Reduction of risky behaviors (especially toxic ones) and maintenance of pharmacological treatment.
- Linking to occupational resources that promote well-being
- Leisure and sports (ordinary or adapted).
- Volunteering (in some cases and times).
- Education (IES, PFI, Cycles, Second Chances, ordinary with adaptation or adapted resources, etc.).
- Pre-employment or employment (both standardized and adapted).
Returning to the community , once the acute phase has passed, can lead to a tendency towards isolation, or a lowering of guard and consumption of toxic substances. For this reason, it is common for some families, in order to have more support and availability, to consider the possibility of obtaining a disability certificate or a subsidy to care for minors with serious illnesses (CUME). In this case, the issue must be approached in a very personalized and individualized way, always involving the affected person and remembering that it is an intimate and reviewable certificate. In addition, it is necessary to remind the young person and their environment that the objective is always functional recovery (which occurs in most situations). The same can be applied to the Law on Dependence.
If you have to take care of your child, you can request a paid reduction in working hours.
For family management, individual, family and group interviews can be carried out, as well as putting them in contact with "expert families" who have successfully managed a similar situation, and who we can find in associations of relatives of people with mental disorders. In the event of relapse, it is always necessary to consider that it is not a failure but a possible episode within the functional recovery and the process of awareness.
Working on social skills in a group
Once the most acute phase of the illness has passed, and when the person and their environment have become aware of the diagnosis, social skills groups can be held. These groups are a useful tool for addressing everyday aspects and can be conducted with the support of the teaching teams in the hospital, nursing, psychology or psychiatry classroom.
While with families the format can be more standardized, with visual aids, questions and debates, with adolescents the response tends to be better through role play or the participation of a person with personal experience in mental health.
Some of the topics that families usually raise in group sessions are:
- What is typical of adolescence and what of adolescence.
- How to get your teenager to go out.
- How to prevent him from consuming toxins.
- How not to become a policeman or a servant.
- Training trips.
- Occupational outings.
- The CUME, dependency, disability.
- How to make him take the treatment properly.
- The discharge of the main caregiver and the recovery of previous activities.
Some of the issues that young people tend to raise are:
- Return to school or institute.
- The fear of being left hanging.
- The fear of meeting with peers.
- What happens if your partner or friends see you taking medication.
- The stigma.
- Go out partying and change habits.
Step into the adult network
Regarding referral to the adult network , in the case of Catalonia, for adolescents who are not linked to a Child and Youth Mental Health Center (CSMIJ), referral to the Adult Mental Health Center (CSMA) is worked on directly with them, where there are specific programs for attention to psychotic episodes. Depending on the area and profile, they can also be referred to Individualized itinerant care programs or teams. Before discharge, therefore, it is essential to specifically work on the adolescent's autonomy and what the role of the family should be in the entire process. Preparing a specific interdisciplinary and descriptive report is very useful for the receiving team.
Before discharge, therefore, it is essential to specifically work on the adolescent's autonomy and what the family's role should be in the entire process.
In those situations susceptible to risk due to low awareness or non-cooperative behavior, intervention is coordinated with social work from the CSMA and professionals from the Primary Care Social Services (SSAP), who often already provide occupational support. In more complex situations, joint work can be carried out with Juvenile Justice (in situations of probation, for example).
It is important to offer families the opportunity to join a family association, while respecting their time and wishes.
And at 18, what then?
As conclusions we could say that:
- The interdisciplinary approach, and specifically that of social work, can have a positive impact on the understanding and management of the diagnosis of a psychotic disorder.
- At any time during the disorder it is possible to work on the autonomy of the adolescent and their environment.
- In each situation, an individualized plan must be developed, involving the person being cared for, their environment and community resources, whether they are minors or adults.
- It is essential to avoid isolation and promote support networks.
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