Welcome to Totara House
Early Intervention in Psychosis Service
- Who is Totara House for
- Totara House philosophy
- What we do at Totara House
- Treatment
- Policy on alcohol and substance abuse
- Questions you may have about Totara House
Who is Totara House for
Totara House is a specialist multidisciplinary service for young people
(aged 18-30) who live in Christchurch (New Zealand) and are experiencing their
first episode of psychosis. For those not
living in Christchurch, contact your local GP, health centre, or mental health
service. Totara House is an "early intervention in psychosis" service. This
means we treat people as early as possible in a psychotic episode and aim to
assess people who may be showing early signs of developing psychosis. Psychosis is a form of mental illness in which people have experienced
difficulty with their thinking. This may result in abnormal beliefs,
perceptions or thought processes. Further information on this is available in
the section What is Psychosis. Research and clinical experience show that the earlier the treatment, the
better the outcome. We provide a service to young people who experience their first episode of
psychosis. They may be in the early stages of, or recovering from, a psychotic
episode. Our service is: There is a strong emphasis on client empowerment and (where appropriate)
family involvement. We actively seek those who may be experiencing psychosis in order to reduce
the duration of untreated psychosis. Our early intervention programme aims to: There is a strong emphasis on client empowerment and
(where appropriate) family involvement. We actively seek those who may be experiencing psychosis in order to
reduce the duration of untreated psychosis. Our early intervention programme aims to: The experience of psychosis can damage self esteem and increase anxiety.
A person may withdraw from everyday activities, and become socially isolated.
When this happens in adolescence, or young adulthood, it can be particularly
devastating. It disrupts the process of normal development to healthy
adulthood. The Totara House programme therefore provides opportunities to: At Totara House we: At Totara House
treatment is provided through: After the initial assessment the client is assigned a case manager -
usually one of the team members who was present at the assessment. The case
manager will co-ordinate care during the person's time at Totara House. The
case manager has the role of ensuring that individual needs are met. This may
include providing support, helping understand about psychosis, linking with
other aspects of the programme, and helping access outside services where
appropriate. During the first month or so, our staff will work together with
the client, their family (if appropriate), and any one else considered
important by the client, to develop a thorough assessment of needs and develop
a "care plan". Our group programme provides a variety of groups that are designed to meet
the current needs of clients and help them get back on their feet. Groups
which may be offered include: Award-winning art from our Art Group Learning from each other, especially from peers, and discovering you are
not alone, are great ways to move forward. Therefore we encourage
participation in groups, which are a combination of fun, information, sharing,
learning, and support. Family Work
When young people start behaving differently, or seem to be in some sort of
emotional crisis, families are usually worried, have lots of questions, and
want reassurance. They usually want information about psychosis, mood problems,
diagnoses, and medications. Sometimes other close friends or support people
find themselves with similar concerns. Often families have issues about
independence, setting rules, how much alcohol is OK - the normal kinds of
issues families grapple with. Families may want different levels of involvement at different times, and
Totara House will involve them as much or as little as the client and family
want in planning an individual programme. Family sessions may be arranged by
the case manager or social worker to explore some of these family issues. Evening education and support sessions are
available for family members and support people on both a time limited and
ongoing basis. A number of families meet regularly for sharing experiences, information and
support, and have found this to be very worthwhile. During the client's first few visits to Totara House they will be introduced
to their doctor, who will work alongside them and the case manager to ensure
their needs are met. The doctor is responsible for overall care in conjunction
with the multidisciplinary team. People with psychosis usually need medication as part of their treatment. It
is likely that the doctor will prescribe medication and may arrange other
medical investigations. These medications are fully discussed with clients.
Many people who come to Totara House have questions and worries about the
effects of taking medication, and we work hard to ensure that as much
information as possible is made available. If the client has any concerns at
all about medication, they are encouraged to discuss this fully with the doctor
and case manager. Recently a number of new medications have become available which are
extremely effective in managing psychotic symptoms and have few side effects.
When medication is prescribed, our philosophy is to use the lowest possible
dose, and only for as long as required. There is a lot of evidence that people recover more quickly from psychosis
if they have psychological treatment as well as medical assistance.
Psychological treatment aims to help people understand and re-evaluate the
experiences they have when developing, during, or following psychosis.
Understanding reduces fear and increases one's sense of control and
independence. Most people will be offered group treatment, but many will also
receive individual treatment when it seems like it might help. Psychological
treatment can also be offered to assist with other difficulties such a low
mood or anxiety which often occur after or during a psychosis. Totara House staff come from many different backgrounds ( nursing,
occupational therapy, social work, psychology, and psychiatry). This means
case managers can draw on a wide range of experience and expertise when
working with clients to develop an individual "Treatment Plan". If
clients require specific expertise in any area their case manager can refer
them or thir caregivers to the team member with that specialist skill. As part of our routine assessments and reviews, various rating scales are
used. The results of these will be placed on clinical files to evaluate an
individual's progress. They will also be used in a way which does not identify
specific people to evaluate our service. This service evaluation may be
published, but there is no way information could be linked to any individual.
Evaluation of our service is also helped by the use of client, and family,
satisfaction surveys. From time to time we hope to conduct research projects within our service. Research will assist us in evolving a service which is responsive to our
clients needs. Policy on Alcohol and
Substance misuse
Illegal drugs, solvents, and alcohol are sometimes used because they seem to
reduce stress and anxiety, alter mood, or help relieve psychotic symptoms.
However, there is increasing evidence that alcohol and substance misuse can: For these reasons Totara House encourages: Clients are not able to attend groups while intoxicated, and will be asked
to leave the premises. If you have alcohol or illicit drugs at Totara House you
will also be asked to leave and may be banned from the premises. Police action
may be initiated under the Misuse of Drugs Act. Totara House will not tolerate possession, use of, or dealing in alcohol or
illicit drugs at Totara House or in the immediate vicinity. Questions you
might have about Totara
House How often will I attend Totara House? Totara House is an outpatient programme. How long you choose to stay
involved with the programme, and how frequently you attend will vary from
person to person. Some people come several times each week, and may continue
doing so if they are feeling particularly vulnerable and in need of a lot of
support. Others may be studying or working and attend less frequently. Some
may be involved in the programme for less than three months, but we generally
anticipate that people will develop an ongoing relationship with Totara House
for one to two years. What if I feel too anxious or shy to come to Totara House? Many of the Totara House clients feel like this about coming to a new place
or meeting new people. No problem! We are happy to come and talk with you at a
safe place where you feel comfortable. This might be at home, at work, at a
coffee bar, or some place else. After you get to know us a bit better and feel
less anxious, we are confident you will feel OK about starting to come. We
will fit in with whatever is best for you. Who else goes to Totara House? We have provision for 96 people on our case load at any one time. We are
funded for people between the ages of 18 - 30, although the majority are
between 19- 25. What if I can't keep an appointment? If it is difficult for you attend, please discuss with your case manager and
we will try to make alternative arrangements. Please advise us as soon as
possible of any difficulties so we can avoid delays in making another
arrangement, and to minimise disruption to others. How much will it cost to attend Totara House? The service is funded by the government as part of the Mental Health
services provided by Canterbury District Health Board, and is free of charge.
However, you may be asked to pay some nominal costs, such as for craft
materials and social outings. If you are on a benefit or student allowance,
your case manager will talk with you to make sure you are receiving all your
entitlements. What if you want to talk with my family or support people? This is often a difficult time for your family or support people, as they
may have questions and feel they need support themselves. It may be helpful
for us to be able to speak with them to understand fully what the difficulties
are and how we can best be of help. If you feel strongly about this,
please speak to your case manager. What if I think I am becoming unwell? Sometimes a person may experience another episode of psychosis. Once you
and your case manager have worked out your crisis plan, you will feel more
able to recognise warning signs and will know what you can do to cope.
If you feel that you are becoming unwell you should tell your case manager or
doctor immediately. Liaison with others: We usually work closely with GPs, counsellors, and others involved in your
care so that we are all working together to provide you with the best possible
co-ordinated treatment. We encourage every one to have a GP so there is at
least one person we can communicate with who is aware of all your health
needs. Any information given about your treatment will comply with the
provisions of the Health Privacy Code and other relevant legislation. Who can I get hold of in an emergency? During the hours of 8.30 am - 5.00 pm, Monday to Friday, you or your family
can phone Totara House on Ph: 3779733 and ask to speak to your case manager or
the Duty Person. In an after hours emergency, the Psychiatric
Emergency Service (PES) is available, 7 days a week, on Ph: 3640482.
The case manager will also discuss the "early warning signs"
which indicate a person might be becoming unwell, in order to reduce the
chances of this happening again. Once the client knows what to look out for,
the client and their case manager can develop a personal plan or "Crisis
Plan" so they are aware of what to do and who to contact in this
situation. This is another technique to help the client feel more in control
of their life.
