Dr. Kenneth Fung (L) and Jian Yang discuss a patient's case. The two will work together to provide the right treatment and support to stabilize the patient through TWH's Early Intervention in Psychosis program (EIP). (Photo: UHN)
In 2011, standing over a hospital bed where her son lay tormented by symptoms of mental illness, Tao saw her dreams for her only child's future begin to disappear.
Tao (not her real name) and her family had immigrated to Canada from China in 2004 with great hopes for their son's education and future.
But after finishing high school with top marks and offers from four prestigious universities, Tao's son Chi (also not his real name) began to fall apart.
Toward the end of high school, Chi began to experience heart palpitations. The family had no knowledge or awareness of mental illness and took their son to see a heart specialist who said Chi's symptoms were related to anxiety and depression.
Despite being referred to a specialist and prescribed medication, Chi's condition worsened. After his high school graduation, he developed a fear of going outside and confined himself to the family home. His symptoms eventually got so bad that he was hospitalized for a month in an effort to stabilize him. Most likely, Chi was experiencing his first psychotic episode of an emerging mental illness.
"Our life was suddenly ambushed with these overwhelming challenges," recounts Tao. "Chi was an excellent student with so many opportunities ahead of him and all of a sudden he was very sick, and we didn't understand his illness or know what to do."
"Tears filled those days in our family."
Chi continued to deteriorate after being discharged from the hospital. Despite Tao's conviction that her son's new medication was making his condition worse, she felt his doctor wasn't taking her concerns seriously. She watched her son becoming paranoid, not feeling safe anywhere; he began to hear voices and even attempted suicide.
As a relative new comer to Canada, Tao and her family didn't know where to turn for help and, despite the best attempts of hospital interpreters, a language barrier still existed when trying to communicate her son's case to healthcare staff. Tao had to quit her job to stay home and care for Chi all the while losing hope that she could salvage his future.
Searching for a solution
While researching experts on the Internet that might be able to help Chi, Tao came across an article on a Chinese language website about Jian Yang, a mental health clinician with Toronto Western Hospital's
Asian Initiative in Mental Health (AIM).
The team at AIM provides psychiatric services in English, Mandarin and Cantonese and focuses its programs on the Asian community in Toronto.
It didn't take long for Tao to get a referral to see Yang and find out if there was anything that could be done for her son. It turned out there was a lot that could be done.
AIM is home to the
Early Intervention in Psychosis Program (EIP), a little known program geared toward Mandarin speaking people in immigrant communities who are experiencing their first psychotic episode.
EIP psychiatrists and clinicians work with patients after their first psychotic episodes over a three year period to stabilize them, treat them, and get them back to their normal life. The patient's family also takes part in the program receiving support and services to understand how they can help in their loved one's recovery.
"The earlier a patient is treated after their first psychotic episode, the more potential they have to recover; patients are less likely to respond to either medication or interventions the longer their mental illness goes untreated," says Dr. Kenneth Fung, Psychiatrist and Clinical Director of AIM.
"The factors that already make mental health awareness challenging, such as stigma and lack of education, are multiplied in the Chinese immigrant community," he continues. "As a whole, immigrants are less likely to find mental health services and they get treatment late if they do, so our program is geared towards helping this population."
In the general population, first psychotic episodes mostly occur when patients are in their late teens and early twenties. Among immigrant groups, there is great potential for psychotic episodes as a reaction to immigrant stresses – like learning to live in a new culture, starting over in a foreign country and the pressures to succeed – either during or after the immigration. As a result, it is unique to the EIP to see a wider age range of patients with first time psychosis than other programs that don't cater specifically to immigrant groups.
For Tao, finding EIP and seeing that there was a chance to move forward with a care plan allowed her to hope again.
"The nightmare of my son's illness slowly became a dream of recovery," she says. "EIP changed his destiny."
Chi was assessed and enrolled in EIP where Dr. Fung and Yang worked to clarify his diagnosis and find the right medications to stabilize his symptoms.
Renewed hope
It turned out that Chi's diagnosis was more complicated than just a psychotic disorder, but since both Chi and Tao were able to talk about his symptoms and the disease progression in their native Mandarin, Dr. Fung was able to tease out that he was not only showing signs of schizophrenia, but was also on the autistic spectrum.
"When there are other conditions in addition to mental illness at play, things can get confusing for clinicians," explains Dr. Fung. "So despite Chi being seen at really good clinics, due to the language barrier his clinicians failed to recognize the scope of his problems and time was lost pursuing the wrong treatments."
As part of the program, Chi and his family attended one-on-one sessions, either together or separately, with both Dr. Fung and Yang. Chi's family also attended the Multi-Family Psychoeducation Group with other families enrolled in EIP – a support group for families to share tips on how to cope with the challenges of caring for someone with mental illness.
"We help our patients deal with their emotions and try to cope with their illness in rational ways through psycho-education," says Yang. "And for family members, we try to get them to understand their loved one's limitations and behaviours."
Four years on, Chi is doing well. He is earning top marks in his studies after returning to university in 2013. He is thinking about going to graduate school and perhaps pursuing a career in research. He is also starting the transition from EIP to AIM where he will receive continued support through a less intensive program.
"I'm feeling better than before but still get anxious sometimes," Chi says. "But I use the strategies I've learned to confront those feelings."
Tao has been able to return to work and hopes that more families will hear about EIP so that it can help more people. Her confidence in Chi's future has been renewed.
"Dr. Fung and Yang not only saved my son but also my family," she says. "I hope Chi will one day make a contribution to Canada because this country has helped him so much."
