AS a teenager, Lee* often found himself in trouble with the law. His behaviour caused problems to his flatmates and he was not turning up for his training course.
He went travelling. His worried parents hoped the experience would help their son sort himself out, but they had to bring him back home.
"They had been saying to the GP that there was something wrong with him, but the doctor said his mood might be a bit low. He ended up coming to us," said Mike Kelly, a consultant nurse at Dorset HealthCare NHS Trust.
After a brief spell in hospital and seven months of support from the trust's mental health team, Lee is applying himself to his work; is not using drugs, and is no longer getting drunk and getting into fights. "His parents feel they have got their son back," said Mike.
Lee's experience is an example of how giving young people the right help when they start showing signs of mental illness can head off long-term problems.
Dorset HealthCare Trust's Early Intervention in Psychosis Service is one of 50 set up around the country this year.
Psychosis is severe mental illness affecting the whole personality, in which the sufferer loses a sense of reality. Symptoms may include hearing voices, changed perceptions, feeling suspicious, experiencing distressing beliefs and thoughts, and altered behaviour, such as becoming more isolated or less motivated.
"The idea is that anyone from 14 to 35 experiencing their first episode of psychosis will get specialist input and care," explained Mike, who is the clinical leader of the team. "The unique thing about us is that we have a nurse-led service."
The team helps clients understand what is happening to them and tries to reduce their mental distress, working with them and their families.
Practical issues such as accommodation, education, employment and social needs are looked at, as well as ways of increasing people's ability to cope with their problems.
"The underlying philosophy is based around recovery, helping people get back to normal life, back into education, despite having had a psychotic episode. The key thing is the idea of working with the person on what's happening in their world rather than what's happening in their head," said Mike.
"It's not about telling young people how to live their lives. On things like substance misuse, which is a big problem, we don't dictate to them. We offer them education about the hazards and the possible risk factors for further episodes of psychosis."
Most of the young people the service deals with are around the 17 to 21 age group. "Psychosis tends to start in males around 17 or 18, a little bit later in women," said Mike.
He stressed that anybody could become psychotic, with events such as going to college, parents divorcing, exams, and substance misuse common contributory factors.
"We've had about five people who have gone to university. We'll support them when they come back on holiday and we liaise quite closely with the people providing care in the other areas."
Mike would like to raise public awareness of psychosis so people seek help before their illness does too much damage. "Early intervention is common sense. The big hurdle is getting over the stigma," he said.
"Research indicates that from somebody having psychotic symptoms to receiving care or treatment can be anything from one to two years. We want to reduce that to three months.
"It's often a relative or carer who approaches the GP, usually after a crisis of some sort. Most people don't recognise the symptoms until the person is doing or saying bizarre things."
One problem is that signs such as loss of concentration, low mood, withdrawing from friends and family, or a sudden drop in academic performance, could be blamed on drugs or depression. "If there's a suspicion, if GPs aren't sure, they should refer," said Mike.
* Name has been changed.
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