Inside a non-descript office building near Billings Bridge, health professionals, social workers, therapists and more are helping young Ottawa-area residents find their lives again after sometimes terrifying episodes of mental illness.
The Ottawa Hospital’s On Track program was one of Ontario’s first early psychosis intervention programs. For 20 years, it has been helping clients across the region do “astounding things” after being treated for psychosis and, often, schizophrenia. Some return to school, some resume high-profile careers — including as lawyers and doctors — and others find new passions.
The program is built on the understanding that the chances of success are far greater if the illness is treated early. There is no cure, but there is great management available for psychosis that enables many people to live successfully with it, similar to other chronic diseases, program psychiatrist Dr. Sarah Brandigampola says.
The trouble is, few people even know recovery is possible. Brandigampola wants more people to understand that there is life after psychosis, especially when it is treated early.
“There is a lot of hope in this illness,” she says.
“You see people when they are so bad. In that moment they have no hope and they don’t see any, especially with schizophrenia. There is so much stigma attached to that word and they don’t know it can be OK,” Brandigampola says.
“The reality is 70 per cent of people with schizophrenia do well. We are hoping to increase that number, but the majority of people, especially at this clinic, do wonderfully. If we can have a successful intervention early on, people do so well.”
The clinic treats youth and young adults between ages 16 and 35 who have experienced a first episode of psychosis or who are displaying warning signs of psychosis.
Clients can be self-referred or can be sent by a family doctor. Often they have spent time in hospital after a psychotic episode before beginning the program.
The experience can be devastating and leave clients shocked, recovering from trauma and coping with cognitive deficits associated with psychosis. It can seem an impossible path forward, but members of the team at On Track say they have learned, from experience, about what helps young adults get their feet back under them so they can see hope and begin recovery and remission.
Key to that recovery is medication. Clients receive medication through the clinic, usually by injection. It usually prevents further symptoms such as hearing voices or hallucinations. People who need anti-psychotic medication are generally on it for life.
Other symptoms of psychosis can be harder to treat, though, specialists at the clinic say. Those include cognitive deficits and symptoms similar to depression, withdrawing from society and lack of interest in activities or other parts of life that used to bring meaning.
Dr. Mary Marquardt, a neuropsychologist with the program, calls those the hidden symptoms of psychosis. “Everybody knows about the hallucinations. But (clients) are often left with negative symptoms and cognitive symptoms and there aren’t any medications or treatments for those. The person looks like they are recovered, but they have changed and are not able to get back to their day to day lives.”
Among treatment offered through the clinic is cognitive remediation, a computerized training program that helps improve working memory and processing speed and teaches cognitive strategies to help clients cope with changes to their cognitive functioning.
The program offers support from nurses, social workers, a dietician and recreational therapist.
Sean Dellaire, who runs the recreational therapy program, says it can be something such as sports or art that helps people take steps toward their old lives.
“We see these moments when things begin to click. People will say ‘this felt like therapy’ when they play sports,” Dellaire says.
Often, though, recovery comes gradually.
Dellaire says peer programs that are part of On Track can make a big difference for many clients because there is no judgment about their experience and none of the stigma that exists elsewhere.
“This group includes some of the most inclusive, nice, kindest people I have ever met. The stigma says the opposite, but what I see is just one of the most inclusive groups there is and it is a great group of people that have had something terrible happen to them,” Dellaire says.
Sumaya is among graduates of the program. She was finishing an undergraduate degree and battling stress when she first experienced a psychotic episode around age 22. She asks to be identified only by her first name because of the stigma.
She describes the experience as feeling like she was underwater. “It was very sudden.”
It eventually took two stays in the hospital for her to be stabilized enough to be referred to On Track. By then, her life was on hold.
She spent a full three years with On Track and was able to get on medication and support to eventually finish her degree and get on with her life.
“Without On Track, I don’t know where I would be.” Sumaya says it helped her structure her thinking to understand she was a person living with an illness, not the illness itself.
“I am the same person that I was before I had this new experience and I am living with it.”
Today, she is working and writing a novel while “trying to navigate normal life after something traumatic.”
Dellaire is among staff who describe the program as a “dream job.” But there are challenges.
Increasing use of cannabis — which can trigger psychosis — adds another layer of complexity to helping put people back on track.
Cannabis is linked to a rise in cases of schizophrenia, Brandigampola says.
“Our understanding of cannabis has changed dramatically in the last few years. Cannabis definitely can cause schizophrenia.” In many cases, she says, there is a genetic element as well, but she notes that cannabis can cause permanent changes in the brain that end up resulting in schizophrenia.
“The challenge with cannabis is that it is legal and the perception is that it is a harmless substance.”
Meanwhile, some clients might depend on it in an effort to cope when what is going on. She says the program generally takes a harm-reduction approach and encourages clients to reduce consumption as a starting point.
Edgar, another client, says he was finishing his last semester of university, “not doing the best, personally, smoking a lot of week, not really attending classes,” when he had a psychotic episode.
He was reluctant to fully participate in the On Track program at first.
“I didn’t think I needed support. I thought I could do it on my own,” Edgar says.
Eventually he realized he needed more support and became more proactive. With the medication, he became more stable and got a job.
Prior to psychosis, Edgar’s future plans were to get into the business world, but his experience changed him. Today, he is a housing case worker with an immigrant program in Ottawa and has an mental health advisory role with the Ottawa Police Service.
He says it is important to him to help the community and to give back after he received such crucial help.
Staff members with the program do outreach to inform front-line health workers at universities and elsewhere of possible warning signs of psychosis in order to try to start intervention even before a psychotic episode.
Outreach is also part of an effort to de-stigmatize an illness that few people are comfortable talking about.
“There are many people living with schizophrenia, but, because of the stigma around it, they don’t want to talk about it, and then as a society we don’t get to see the success stories and then we don’t have a chance to diminish the stigma around it,” Brandigampola says.
Our website is your destination for up-to-the-minute news, so make sure to bookmark our homepage and sign up for our newsletters so we can keep you informed.
