An alliterative journey: on mental health, multidisciplinary management, medications, mindfulness and more
In this week’s entry, I am proud to introduce readers to a novel research project here at OHSU called Meals, Mindfulness and Moving Forward (M3). Before doing so, however, it’s important to talk about mental health, psychosis, and Oregon’s Early Assessment and Support Alliance – an essential partner in the M3 Pilot Study.
Mental health, the capacity to meet emotional and intellectual challenges at different developmental stages, is among parents’ greatest concerns. Thus, when a child, or more often an adolescent or young adult’s developmental path suddenly becomes fraught with obstacles – personality changes, memory problems, even hallucinations or unusual, frightening ideas – families are often alarmed and at a loss for what to do.
What I just described is what happens when young people are showing signs of psychosis. Psychosis is a generic term that sometimes refers to mania (characterized by an episode of extremely heightened emotion, diminished need for sleep, reckless behavior, rapid speech, thoughts that seem to dance from one idea to another) or schizophrenia (which may involve hallucinations, delusions, or a loss of functioning).
When a young person demonstrates these signs, families often wonder:
- Will my child always struggle with this?
- What can make this better?
- What will make it worse?
- Can my child achieve his or her dreams?
To this last question, a decade ago some brave Oregonians answered with an emphatic: “Yes!” This group, centered in Salem, Oregon, formed the Early Assessment and Support Team (EAST). EAST’s mandate was to research and implement best practices when it came to supporting young people impacted by psychosis.
Two of the central tenets of EAST were that the earlier we intervene with adequate treatment, the better, and that families, friends, and those surrounding a young person are not a barrier to recovery but are instead essential to recovery – no more treating individuals in isolation! Engaging families and providing good service coordination and nursing and psychiatric care, along with school, employment, and housing support helped young people get out of the hospital and stay out. They were working, learning, and growing. Well, word spread of EAST’s success and eventually EAST became EASA — the Early Assessment and Support Alliance, now active in nearly every county in Oregon. You can learn more about this unique, multi-disciplinary approach to mental health treatment at easacommunity.org.
One dilemma in EASA programming, which is shared with “early intervention” programs around the world, is that, while some young people achieve recovery without use of antipsychotic medicine, many individuals find antipsychotics key to overcoming challenges. Unfortunately antipsychotics usually promote weight gain and this side-effect, combined with decreased motivation or fear of leaving one’s home, can cause many young people significant, lifelong health problems. To meet this challenge, generous donors brought together Dr. Lynne Shinto, a naturopathic researcher in the Department of Neurology and me, a child and adolescent psychiatrist here at OHSU Doernbecher Children’s Hospital. Together with research coordinator Andie Thompson, MsCN, we built a lifestyles’ intervention program aimed at promoting resilience and fitness in young people impacted by psychosis.
In our study, we have partnered with the Clackamas, Multnomah, and Washington County EASA Programs to recruit 20 participants ages 15-25 and 20 study partners (individuals who may help the work continue outside of sessions) to come to OHSU’s Center for Health and Healing for a 6-week lifestyles training program that involves mindfulness meditation, yoga and other light activities, as well as hands-on cooking/grocery shopping instruction.
The primary aims of our multi-modal study are to find out if people show up and enjoy the sorts of activities we’ve planned. Meanwhile, we are also collecting data on weight and cholesterol, on psychiatric symptoms, as well as a self-report measure of resilience—one’s internal sense of being able to meet a challenging thought or interactions—which research suggests is enhanced by mindfulness meditation.
We hope that qualitative and quantitative data from this pilot project helps EASA and other early intervention programs develop creative means of engaging young people in healthier eating, activity and mindfulness practices. Click here to learn more about the M3 Study and our valued collaborators (including Street Yoga and local chefs Sonny DiMartini and Arielle Clark). Stay tuned for an update on our outcome measures!
Craigan Usher, M.D.
Clinical Associate Professor
Oregon Health & Science University
Consultant, EASA Center for Excellence at Portland State University