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A Year “Down Under"

ORYGEN Youth Health

Steve Mathias

Reprinted from "Treatment for Young People" issue of Visions Journal, 2006, 3 (1), p. 28-29

In 2005, as a fourth-year psychiatry resident, I was given the opportunity of a lifetime: with the support of UBC’s Department of Psychiatry, I travelled “down under” to Melbourne, Australia. There, I worked for one year at ORYGEN Youth Health in the Substance Use Research Recovery Focused (SURRF) program.

ORYGEN Youth Health is a service provided to the northwestern and western suburbs of Melbourne. Servicing a region of over 800,000 people, ORYGEN grew from its early beginnings as the Early Psychosis Prevention and Intervention Centre (EPPIC), founded by world renowned psychiatrist Dr. Patrick McGorry. Today, ORYGEN has over 300 clinicians and researchers working with youth, 15 to 24 years of age, in all areas of mental health. The ORYGEN inpatient unit and a multitude of clinical programs are located at three sites in Melbourne.

The 24-bed inpatient unit is available for those young people needing a brief hospital stay due to concern for their safety. ORYGEN prides itself in using low doses of medications and using a hands-off approach, minimizing the use of restraints and seclusion in what is often the youth’s first contact with mental health.

The numerous clinical programs address the common mental health problems of youth: psychotic, mood, anxiety, substance use, eating and personality disorders. The care model is that of case management, where a therapist is assigned a caseload ranging from 20 to 35 people. Therapists see the youths regularly, helping them attend vocational programs, schools and various groups. The therapists provide supportive therapy to the youth and, whenever possible, their parents, while serving as a link to medical staff. ICM, or Intense Case Management, is a group of energetic, highly committed workers who support the treatment of challenging youth, either because of the severity of their illness or because of social factors such as drug use and homelessness. The Youth Access Team (YAT) is available 24 hours a day, taking phone calls and doing home visits to youth in crisis. YAT is also responsible for all intake assessments and acts as the referral point for all the other clinics.

The SURRF (Substance Use Research Recovery Focused) program was established in 2003 under the leadership of Dr. Dan Lubman and is funded mostly through research grants. In my brief time with SURRF, I was involved in several research projects. I worked with various drug and alcohol agencies, educating staff on mental illness issues and consulting on youth who had both addictions and mental illness. I also worked with the ORYGEN inpatient unit and several of the clinical programs to increase staff awareness about the impact of substance use on mental illness. I trained staff on how to assess for substance use as well as on the use of motivational interviewing techniques.

Some of my most satisfying work came as a case manager within SURRF, as part of an ongoing study of youth suffering with both depression and substance use disorders. To them, I was “Doctor Steve from Canada”— somewhere between a celebrity and a circus act! My interactions with new patients began with them guessing, based on my accent, where I was from— they usually guessed Ireland or the United States!—followed by a conversation about Canada or my travels in Australia. My trump card, especially with the young men who often didn’t want to talk, was my interest in the Western Bulldogs, an Australian Rules Football team, perennial underdog and local fan favourite. Most of my patients either “barracked” (cheered loudly) for the Bulldogs or had a soft spot for them. Being able to talk “footy” was incredibly useful in establishing rapport.

Attempting to simultaneously address substance use and mood symptoms is a challenge, since one often triggers or perpetuates the other. The youth cutting back on his marijuana use often sees his irritability increase. Or, attempts to improve mood may include drinking more alcohol. The pilot project involved the design of a treatment manual, combining motivational interviewing techniques to address substance use, with cognitive-behavioural therapy (CBT) to address mood and anxiety issues. Therapy was focused on current stresses and was very much patient-centred and -directed.

I discovered that CBT was beneficial for many of the youths who had grown up with neglect, low self esteem or low self-worth. Learning how to correct their negative thoughts, or how to challenge their automatic assumptions that the world was unsafe or that their future was without hope, was new and exciting. While change occurred gradually and over several months, it was rewarding when my patients stopped seeing the world around them as a frightening place.

I cherish my year working with the ‘Aussie’ youth of Melbourne. I made friendships that will last a lifetime and I am indebted to UBC, the University of Melbourne, ORYGEN Youth Health and Dr. Dan Lubman for providing me with this memorable and valuable opportunity. “Go Doggies!”

About the Author

Steve is a staff psychiatrist at BC Children’s Hospital and the Maples Adolescent Treatment Centre

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