The term psychosis describes disturbances to thinking, perception, emotions, language, sense of self and behaviour. Someone with psychosis may hear or see things that others around them do not, or they may have thoughts and beliefs that are not based in a shared reality. They may also experience problems with cognitive functions such as memory and decision-making. Psychosis affects as many as one in 200 people, and can be a one-off experience or part of a psychotic illness such as schizophrenia, schizoaffective disorder, or bipolar-affective disorder, which typically occur for the first time in teenagers and young adults. It disrupts people’s lives, often making it difficult to study, work or pursue satisfying relationships. Worldwide, schizophrenia alone accounts for 2.8% of years lived with disability, and it also shortens people’s lives. Australians with a persisting psychotic disorder die on average 10 to 20 years younger than other people, mainly from heart disease, diabetes or other physical illnesses. People living with psychosis are also at high risk of suicide.
The Mindgardens Psychosis Flagship has been created to bring together medical care, psychosocial support and research into psychotic disorders in an integrated, expert centre. Through the Flagship, based at the Randwick Health and Innovation Precinct (RHIP), people who experience psychosis can be confident their care will focus on the impact on their lives – not just on controlling symptoms. Clinical care is linked to support for nutrition and lifestyle in this comprehensive approach that draws upon the expertise of lived experience peer workers and allied health practitioners as well as specialist doctors. By addressing the many dimensions of a person’s life and experience in parallel, the model can reduce the impact of psychosis and support people to live the life they want. The Flagship serves the estimated 4000 people in the South Eastern Sydney Local Health District (SESLHD) who live with psychosis, and can also accept referrals from other NSW districts. Through its unique research and training capability, anchored in lived experience, the impact of the work of the Flagship extends across Australia and internationally, translating research findings into practical insights that can be taken out to people in the community. The Flagship integrates a successful state-wide Apex Clinic known as the Tertiary Referral Service for Psychosis with a suite of research projects. These range from clarifying at the molecular level the role of immune system responses in psychotic disorders, to supporting patients to improve their cognitive function as well as their diet and exercise.
The NSW Tertiary Referral Service for Psychosis
The NSW Tertiary Referral Service for Psychosis (TRSP) is a unique statewide service that offers intensive and individualised treatment and support for people who live with complex psychotic disorders, including schizophrenia and bipolar disorders. Typically, such people have already tried multiple services, often over many years, without finding support that is truly helpful to them. The TRSP, offered through SESLHD, is NSW’s only specialised tertiary referral psychosis service. It aims to set new benchmarks, combining the very best in expert clinical assessments and treatments with professional education and training in higher level clinical skills, family and community engagement, and clinical effectiveness and investigative research. It has potential to be scaled nationally, for psychosis patients with the most debilitating illness and high service usage. The TRSP is rated highly by consumers, with early evaluations averaging 80% satisfaction for quality of overall experience. It offers:
- Individualised therapeutic approaches, including medication, psychological support, physical health care, and drug and alcohol and smoking cessation treatment
- Access to clinical and psychosocial research studies to ensure the most severely affected patients benefit as soon as possible
- Training for clinicians in providing cognitive remediation to patients
“I believe that long term outcomes for people who have a psychotic illness can be improved by offering best-practice care, at the same time as pursuing research into innovative treatments. By listening to people who live with psychosis, and their carers, we can learn how to help them achieve their goals. The TRSP team aims to improve clinical outcomes such distressing symptoms, but also people’s social inclusion, day to day functioning, and ability to have a meaningful contributing life. My work is at the clinical/research interface, and that’s why I really value the Mindgardens framework, which focuses on translation of academic research, making it meaningful and useful to consumers, clinicians and other stakeholders.”
- Associate Professor Julia Lappin
Psychiatrist and Clinical Director of the Tertiary Referral Service for Psychosis
Inflammation and Psychosis
The NSW Tertiary Referral Service for Psychosis (TRSP) is a unique statewide service that offers intensive and individualised treatment and support for people who live with complex psychotic disorders, including schizophrenia and bipolar disorders. Typically, such people have already tried multiple services, often over many years, without finding support that is truly helpful to them. Dr Cyndi Shannon Weickert said more than two-thirds of people admitted to hospital with a psychotic episode showed inflammatory blood markers that indicate an autoimmune reaction – strongly suggesting inflammation is triggering mental illness. It might be possible, she said, to identify and treat inflammation earlier, and avert or reduce the severity of psychotic episodes. As well as identifying new molecules that may effectively treat inflammation in psychosis patients, Dr Shannon Weickert is also seeking to design trials of medications used in other autoimmune conditions, such as multiple sclerosis, to determine whether they may be useful in psychosis. She also plans to investigate cannabinoids, to determine whether their anti-inflammatory properties may explain the relief that some people with schizophrenia and other psychoses experience from smoking cannabis.
“Now that we’re thinking about schizophrenia as a neuroinflammatory condition, we have a renewed opportunity to repurpose anti-inflammatory drugs. We can use drugs that are known to be relatively safe, which really gives us a leg up. But there is a lot of trial and error and we have to be sensible about what we try first, and record a lot of biological information as we go, so that if one drug doesn’t work, we can still learn about what might work.”
-Professor Cyndi Shannon Weickert
NSW Chair of Schizophrenia Research
Keeping the Body in Mind(gardens)
The Keeping the Body in Mind(gardens) (KBIM-G) program addresses the poor physical health experienced by many people who live with psychosis, as a side-effect of mental health medications and as a result of psychosocial and lifestyle issues that make it harder to have a healthy diet and exercise. Current activities of KBIM-G include:
- Developing digital physical health resources for mental health consumers
- Piloting new GP referral pathways for primary care mental health patients to access exercise physiology and dietetic services
- Provision of a Tobacco Treatment Specialist and a Mental Health Peer Worker to assist clients in navigating the system and support them to quit smoking
- Adapting KBIM to ensure it meets the needs of people from refugee backgrounds.