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Helen Silvis of The Skanner News
Published: 26 July 2012

The EASA team: Back row from left: Leticia Sainz, intake coordinator; Keri Ault, counselor. Middle row from left: Emily Reynolds, supported employment, Neil Falk MD, psychiatrist; a psychiatric resident from OHSU; Robert Janz, team leader. Front row from left: Megan Sage, Latino specialist; DeShawn Williams, case manager; Angela Petigranos, case manager; Marrissa Gottlob, case manager.

Plenty of us have days when we feel as if we're losing our minds. Three out of every hundred people, won't just feel that way; they will slide into a psychosis. The younger you are, the higher the risk. Teens and young adults are most likely to be hit with psychosis. That's the bad news.

But the good news is that two of every three people who develop psychosis, will recover completely. They will never have another attack. And it gets better. The one person in 100 who has repeated bouts of psychotic illness, usually can learn to cope with the symptoms and live a normal life.

Yet mental illness gets such a bad rap that most of us falsely believe that the most extreme cases are typical, says Neil Falk M.D., a psychiatrist with the Multnomah County's Early Assessment and Support Alliance, known as EASA.

"The fear for families is that when they hear the words psychosis or schizophrenia, they assume their child is or family member is going to become a homeless street person," Falk says.

"But up to 75 percent will never have another psychotic episode, if you can treat it early with wraparound family services and support."

That's exactly what EASA is set up to do. The goal is to reach young people with psychotic symptoms before they reach a mental health crisis. And it works. Former clients have gone on to graduate from school, build successful careers and become parents.

"We've learned a lot about how to mitigate symptoms," says Robert Janz, EASA's team leader. "What we are really geared to do is to get people back into the normal pattern of their lives. So we focus on things like going to school, playing music, whatever their interests are. We've had skateboarding as part of our plan."

The EASA team offers information, support and hope. Made up of experienced mental health professionals who have helped hundreds of people deal with psychosis, the EASA team includes: Falk, an intake coordinator, caseworkers with cultural expertise, nurses, an occupational therapist, and a jobs specialist. And you won't have to worry about paying for services or medications. The service is free to those who need it.

Just because psychosis is invisible, doesn't mean it isn't a physical disease. Falk thinks of psychosis as something like a heart attack of the brain.

 Based on research from Australia and New Zealand that shows early intervention improves long-term outcomes, the program is one of more than a dozen EASA centers, set up across Oregon to reach out to youth and their families having a first experience with mental illness.

"One young man was out of school for a year," Janz says. "Now he's back in high school and he just went to the prom."

What kinds of symptoms are we talking about?

The basic definition of psychosis is a loss of contact with reality.  It can include symptoms such as: feeling paranoid and anxious, confused thinking, odd and unusual beliefs or behavior, changes in perception such as having hallucinations or hearing voices, racing thoughts, and extreme mood changes.

"You're looking for a change in a person's thoughts or behavior, things that are more odd, unusual, bizarre and out of the ordinary," Falk says. "Sometimes people have symptoms but they don't voice them, so they look more depressed than anything else. You might see grades going down or isolation."

Medication isn't always necessary. Previous generations of doctors and mental health professionals believed a psychotic illness meant you had to take medicines for life – even though the side-effects could be devastating. That's not true.

 "The message wasn't accurate, and it was very discouraging," Falk says. "Now we can say: 'This can, and hopefully will, get better for you. And you're not alone.'"

Falk says today's medications are an improvement on the past. Nevertheless, he uses them sparingly.

"The general philosophy is to use the lowest amount possible for the least amount of time possible," he says.

That's another reason to contact EASA early in the illness. It's easier to keep medications to a minimum. Once in hospital, patients usually are given high doses of medication to bring their symptoms under control. 

 "What I do then is keep people on the meds, unless the side-effects are too bad, for a few months," Falk says. "Then I gradually reduce them."

Just because psychosis is invisible, doesn't mean it isn't a physical disease. Falk thinks of psychosis as something like a heart attack of the brain.

"It takes a long time to recover from a heart attack, and it takes just as long or longer to recover from psychosis," he says.

Our hard-charging culture doesn't make healing easy. Young people are expected to be making strides in school or a career, not taking things easy. And widespread fear and ignorance about mental illness adds another layer of hardship.

"If someone has a heart attack, everyone rallies around. They bring flowers, meals, and they are sympathetic," Janz says. "With psychosis, that doesn't happen. Many families keep it secret. They might not even tell other family members." 

What brings on a psychosis?

The answer is different for different people. But stress is a major factor. Disrupted sleep and drug use – including both street drugs and some prescribed drugs – are just two common stressors. Yet all kinds of trauma, loss, or emotional upsets can make us vulnerable. The teen years bring huge hormonal shifts, as well as new pressures.

"Stress is one of the biggest causes of relapse," Falk says.

EASA staff won't tell you what to do. They will help you figure out for yourself what stresses you, and what you can do to reduce your symptoms.

In human history, hearing voices or seeing visions has often been understood as a religious event. And many people who go through psychosis do find enduring spiritual meaning.  EASA staff respect individual spiritual beliefs, and have even accompanied clients to support them as they visit pastors or other spiritual mentors.

When mental illness gets media attention, it's often because of extreme behavior, such as the public breakdown of filmmaker Jason Russell, who got naked on the street in Los Angeles; or a tragedy, such as the police shooting of Keaton Otis. Otis' mother Felesia Otis talked to The Skanner News about her battle to raise awareness about mental illness.

It's true that when people are out of touch with reality, they may not recognize or obey everyday rules of behavior, Janz says. But those are severely ill people who didn't get help when they needed it, Janz says.

"People don't realize that the majority of folks who have psychosis: nobody knows it. You really can't tell. They are just like everyone else."

You can call EASA 24 hours a day, seven days a week:

For advice, appointments and referrals: 503-988 -3272

For the 24/7 Crisis Line: 503-988-4888

OTHER RESOURCES: The Avel Gordly Center for Healing offers culturally specific treatment for adults with depression, anxiety, psychotic illnesses, addictions and other mental health issues. Call the clinic at 503-494-4745
STORY: Avel Gordly Center for Healing Seeks to Expand Services

Patients Rights movement: Mind Freedom International 541-345-9106

Cascadia Behavioral Health: mental health and addictions counseling: 503-283-3763
Lifeworks Northwest: mental health and addictions counseling: 503-645-9010
National Alliance on Mental Illness: 800-343-6264

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