Raising the Bar and Offering Hope

For Psychology Month, Dr. Sean Kidd, Scientist and Head of Psychology Service, Schizophrenia Division, blogs about the power of higher expectations.

As a psychologist, I spend a lot of my time trying to help people understand that while illnesses such as schizophrenia are major challenges in the lives of our clients and their families, the picture is not a hopeless one. Often depicted in mainstream media as intractable, we need to be reminded that mental illness can also include recovery and a full and rewarding life.

The general tendency is to fear things we can’t understand or what makes us uncomfortable. An illness like schizophrenia does not necessarily mean lifelong impairment. As an individual with psychosis recently shared with me, the message given to her during her first hospitalization was that just like a diabetic who can’t eat a cake, she could never have the life she once hoped she might. She was devastated by those comments which diminished her sense of identity and hope.

Not to minimize the very real impacts of illnesses like schizophrenia, the reality is many of the patients I see can successfully engage in recovery. It may take several years, but some experience a total remission of symptoms and many more are able to have rich lives despite some aspects of the illness persisting. But the first step is to have higher expectations for those with schizophrenia and know that will lead to better outcomes.

And it was this desire to raise the bar that led myself and a team of clinicians and researchers to CAT – cognitive adaption training. This therapy puts in place environmental supports to encourage routines that help people take those initial steps towards a life outside of mental illness. Often these are steps out the front door. The focus in mental health can sometimes be assessment, diagnosis and prescription, but psychologists bring our background in interventions like psychotherapy and intensive training research to every challenge and every patient.

Over dumplings at my favourite restaurant in Chinatown, Dawn Velligan, a prominent researcher and fellow psychologist from the University of Texas at San Antonio, who developed this intervention, helped me hatch a plan to bring CAT to CAMH. The results? After two years of working with clients struggling with the most difficult form of schizophrenia – those with intense negative symptoms and cognitive impacts – something remarkable happened. We saw people tackle their challenges in new ways and make gains those around them previously thought impossible.

People became much more active, were living healthier, had more confidence, and were getting out in their communities. Our clinicians did not make this happen. Rather, they worked together with clients to move some of the major barriers out of the way. Our research showed strong effects in community functioning after treatment, and offered new hope for patients who might have not been expected to do that well in life simply based on their diagnosis. And working as part of a multidisciplinary team with nurses, occupational therapists and social workers, we are finding unique ways to meet the needs of our patients.

With new interventions, the true potential of people can be revealed, even those who are considered hardest to meet their needs and treat. Our research shows that with the right type of support, clients can get a lot further in their recovery than people had believed possible. Nothing can top that – everyone, from family, to clinicians, to the person themselves — making real changes in their lives. I think this goes to show people should re-adjust their expectations about the potential of those with mental illness and realize that raising the bar is going to lead to better outcomes.