October 12, 2018

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Today offered one last fix of the latest in early intervention research and implementation with the International First Episode Vocational Recovery group (iFEVR) and International Physical Health in Youth Stream (iphYs) joint conference.

‘Promoting Recovery of Young People Experiencing Mental Illness: New Frontiers’ was timed to fall after IEPA 11, but it was by no means an afterthought. Both sessions were packed with a program as varied as the disciplines and nationalities represented in the audience.

Robert Walker, from the Massachusetts Department of Health, first welcomed everyone to his city, and praised both groups for their concern with treating the whole person, and ‘putting people back together again’.

iFEVR took over the morning session, with Jo Smith chairing, tackling vocational recovery. We heard from Miles Rinaldi and Cristian Mena about the implementation of the individual placement and support (IPS) program of vocational recovery in two very different contexts – the UK and Chile. Both involved starting small and working their way up. In the UK, vocational recovery is now part of government health policy and guidelines for early intervention services. In Chile, Programa de intervención Temprana en Psicosis.is still in the early stages but they are progressing, with the help of focus group input from users of the service.

Andrew Chanen then outlined his group’s preparation for INVEST, the first RCT of IPS for people with borderline personality disorder (BPD), the first trial of IPS outside of psychosis in youth mental health. Young people with BPD are at a higher risk of unemployment up to 20 years later, and the highest community cost of BPD is the indirect cost of unemployment (not hospitalisation, as many may think). Yet the ‘soft bigotry of low expectations’ means there’s almost no focus on functional recovery in BPD, and no evidence-based interventions for helping young people with BPD get back into to work or education. This may be about to change, and we await the results from INVEST.

Jennifer Humensky talked about the experience of vocational recovery in OnTrackNY, where a specialist-supported education and employment worker has improved initial rates of school and work participation and increased subsequent engagement with other parts of the service.

Gina Chinnery spoke about introducing a new peer worker role into the early intervention service at Orygen. This role works with IPS workers and draws on their lived experience of managing their own careers to support young people. Orgyen is exploring ways to make this available to more young people by trialing vocational support in the moderated online social therapy (MOST) platform.

A series of ‘bolts from the blue’ followed, where various iFEVR members presented two-slide presentations of innovations and inspiration.

  • We recieved encouragement from David Erickson that IPS helps even when baseline employment is high.
  • Jonathan Delman asked us to consider aspects of vocational recovery that IPS might not cover, such as adult needs and providing support for self-employment and entrepreneurship.
  • Jennifer Humensky found that the continuity of IPS provision is as important as how long it’s provided for.
  • Abigail Wright presented evidence that we might need to look at metacognitive as well as cognitive impairment effects on employment.
  • Amy Wilson brought in the perspective of supported education in veterans and showed how a flexible model of care can take support to where it’s needed, and how vocational support can be a valuable engagement tool.
  • Joseph Ventura shared promising results about the enhancing effect of exercise on cognitive training for improving role functioning.

Reflecting the collaborative nature of the conference, the next two sessions invited audience input, relating to key issues for iFEVR. Using sli.do technology, Eoin Killackey polled the audience in real time about the priorities for the next Meaningful Lives statement, which is now in its tenth year and due for an update. The results of the poll will be considered as the next Meaningful Lives statement is developed.

Eoin also looked back to reflect on the group’s achievements. iFEVR has evolved into an international network that people all over can draw on for research and implementation support. Its biennial meetings are a ‘focus for energy and effort’.

More about what was discussed, along with questions and answers from the audience, will be posted on the iFEVR blog, so keep an eye out.

Following an appropriately healthy lunch, iphYs set the agenda. Chaired by Phil Ward, the afternoon also began with some reflection. Jackie Curtis and David Shiers, founding chairs of iphYs, discussed the past, present and future of iphYs – eight years since it started, and five years since the HeAL declaration. They reflected that HeAL really was about raising expectations of young people receiving early intervention services about their physical health, and in that regard, it has provided standards and goals that are now available in seven different languages.

Highlights from the afternoon included:

  • Gail Daumit’s overview of the CHAMPION trial, which is testing the impact of a practical healthy-lifestyle intervention in mental health outreach programs.
  • Nev Jones showing the actual priorities of young people with regard to their physical health as not always aligning with what researchers and clinicians prioritise. In particular, reproductive health (including genetic risk and ability to parent), weight and appearance, and the risks of taking antipsychotic medication are areas of concern, and areas where young people want more information.
  • An update from Phil Ward and Scott Teasdale on the Keeping the Body in Mind program in Sydney, including new domains of intervention, such as tobacco smoking and oral health.
  • Katherine Boydell taking us into the wonderful world of body mapping and how it can help young people understand and express their experiences of physical and mental health. A guided process of tracing a person’s body on silkscreen and then filling in the outline with images, body mapping can also be used to teach the wider community about young people’s experiences. You can see more of Katherine’s work here.

More ‘bolts from blue’ included;

  • Saana Eskelinen on the Health Hut integrated care service in Finland.
  • Lauren Brooke on how sport can aid recovery for FEP, and not just because it involves physical activity.
  • Laura Kernan from the local InSHAPE lifestyle intervention designed for severe mental illness, who shared promising results by improved fitness and weight.
  • Debasis Das told his story of improving physical health assessment and monitoring in a busy, multi-ethnic NHS service in England, using the quality improvement requirements of the UK health system.
  • Amal Abdel-Baki and Ahmed Jerome Romain showed how they not only motivated young people to get active but also motivated mental health professionals who think that physical activity is a ‘lifestyle choice’ that they may have thought themselves as too busy to try to implement.
  • Abigail Lane drew our attention to obstructive sleep apnoea in early psychosis and its negative effect on physical health.
  • Carmen Paz Castañeda and Brian O’Donoghue spoke of the challenges for physical health promotion in Latin America.
  • Brian O’Donoghue finished with preliminary data on the physical health trajectories of young people in the clozapine service in Orygen, which specifically aims to manage the physical health effects of clozapine.

The conference ended once again with a discussion of the future, with iphYs facing similar issues of where to next, agreeing that implementation and knowledge translation is the key. At the end of a day showcasing innovations from around the world, the mood was optimistic and enthusiastic for the future of both groups, with great enthusiasm for the next meeting in 2020 in Rio.