Amid rise in cannabis-induced psychosis, mental health program in Windsor gets young people early help

Tegan Rose's job involves going into the community to support people aged 14 to 35 who have been in a state of psychosis for what's believed to be the first time - and getting them help as early as possi‐ ble.

The registered nurse and support worker is in the early intervention psychosis pro‐ gram under the umbrella of the Canadian Mental Health Association's Windsor, Ont., branch.

Psychosis refers to a col‐ lection of symptoms that af‐ fect the mind and can result in a loss of contact with real‐ ity.

Rose said the program has seen a large increase in cases of cannabis-induced psychosis over the past sev‐ eral years, especially in young people.

"That can trigger psy‐ chosis in people that may have a vulnerable brain, and maybe they did have an un‐ derlying, psychotic disorder, but it's exacerbating symp‐ toms," she said.

"It might not necessarily be an addiction, but recre‐ ational use as well can have a negative impact on symp‐ toms."

Health Canada has con‐ ducted an annual survey since cannabis for non-med‐ ical purposes was legalized in Canada in October 2018.

According to the 2023 survey, cannabis use in the 30 days prior to the research being done remained higher among Canadians aged 16 to 19 years, at 29 per cent, com‐ pared to 23 per cent in 2018. Other studies have indicated a massive surge in emer‐ gency room visits in Ontario between 2014 and 2021 for cannabis-induced psychosis.

People with psychosis might hear voices or see things, have trouble keeping their thoughts straight and experience delusions - a false fixed belief that someone might be out to get them or they're in harm's way.

"One of the big things that we focus on, providing edu‐ cation, is how substance use can affect psychosis, trigger‐ ing psychosis," she said.

Rose regularly meets with clients at their homes. She has a caseload of around 17 people, and often sees each once or twice a week.

She cites various reasons someone may end up in her care and get into a state of psychosis.

"We have some individu‐ als that we would call a pri‐ mary psychotic disorder. There might be a genetic pre‐ disposition. Sometimes we see it occur in individuals with a mood disorder, de‐ pression, bipolar disorder. And sometimes it's also sub‐ stance abuse as well."

According to Rose, despite being in the community and inside the homes of clients, she feels comfortable and safe because of the pro‐ gram's initial intake screening process for potential risk.

"Obviously, we do have some safety precautions and safeguards in the odd situa‐ tion where we might need to make a plan, but the majority of the time it increases acces‐ sibility for the individual."

Rose said she meets with clients where they're most comfortable.

"We really get to see what's going on in their home environment, how they're doing. It really gives us a very clear picture," she said.

3-year program, roughly 30-day waitlist

The early intervention psy‐ chosis program has been in Windsor, in various itera‐ tions, since 2006.

Josh Strong-Gates, manag‐ er of the program, said their multi-disciplinary team con‐ sists of about 10 positions including a handful of nurses, two psychiatrists, an occupational therapist and a life skills worker.

The program currently handles roughly 100 cases, he said.

"Every client will have somebody who is their pri‐ mary worker, who is their point person that is essen‐ tially assisting them in any way that they need," said Strong-Gates.

"Assessments, working with them through medica‐ tion questions, health teach‐ ing - whatever that looks like for them."

According to StrongGates, there's about a onemonth waitlist to get into the program.

"Obviously our goal is to be less than two weeks."

He said clients come from different social and economic background, and they haven't noticed a predomi‐ nant gender.

They've begin accepting clients starting at age 14 to avoid an overlap with pedi‐ atric services.

"In the past, we've had conversations with physi‐ cians where a client might be 13, and we're kind of on that border of should they be going somewhere else … somewhere like Maryvale, or should they be coming to us? That'll be a physician position kind of case by case."

LISTEN | The toll of cannabis-induced psy‐ chosis:

The early intervention psychosis program is volun‐ tary and can last three years.

Strong-Gates said the goal is to get the person stabilized with a treatment plan so they can move on.

"That doesn't mean every‐ one in the program is always here for three years, but that is our capacity, our max."

Although not everyone stays in the program for the full duration, Rose believes being in the program helps in building rapport.

"I actually think because of that relationship, it makes it easier to get them on board with treatment and understanding that you have their best interests at heart. We find the vast majority of clients decide they want to stay for the three years."

Cathy Regier is the pro‐ gram's early intake assess‐ ment nurse, handling refer‐ rals and consulting with the team's psychiatrists.

She said when people are originally told the program can last up to three years, they look like "a deer in head‐ lights."

"I know they're all think‐ ing, 'I'm not staying for three years. I don't even want to be here today.' But after the three years, our clients don't want to leave," Regier said.

'I try to set them at ease'

Part of Regier's job is to look for the symptoms people ex‐ hibit in hospital or in the emergency room before they're referred to the pro‐ gram for assessment.

"They may be dishev‐ elled," said Regier. "They may be irritable. Their thoughts may be scattered. They could have a mood component to it. A thing that is hard to rec‐ ognize is psychosis."

Most of the time, Regier said, they're dealing with young people.

"It's their first time in the mental health system. It's very scary for them. Some of them are repeats, but not many."

According to Regier, as‐ sessment appointments for people seeing them for the first time can last as long as two hours.

"I meet with the client. Usually the parent is there as well and I try to give them a really good overview of what's potentially happened causes for them to start with psychosis, how it affects their brain, and what to expect with treatment and expected outcomes," she said.

"I try to set them at ease a little bit," she said, telling them 'you know that what you're experiencing is really common for somebody your age, and it doesn't mean that this is a forever kind of thing for you."

Regier said that initially, she tries to keep her explana‐ tions simple "so that they un‐ derstand it's common in their age group and that we're there to help them get through it. We try to help them move their goals to be healthy, to stay away from substances and decrease their stress, those kinds of things."

Strong-Gates said the hope is to spot early onset symptoms for psychosis so they're referred early to the program, preventing them from needing acute care in hospital and keeping them in the community.

"If they feel their family member is experiencing psy‐ chosis of any kind, they should bring them to their family doctor, a walk-in clinic or the ER if needed and have them assessed, and that's where a referral can be put into our program."

Regier said it's important to get treatment as early as possible for prodromal symptoms - which include mood changes such as anxi‐ ety, depression, irritability and anger - which parents may mistake for common teenage behaviour.

"They might not be taking care of their hygiene, isolat‐ ing themselves in their room or not wanting to go to school - maybe a little bit confused or disorganized thinking."

Generally, symptoms will increase, said Regier, and sometimes it's the schools that reach out to families and the CMHA program asking for advice.

"Symptoms can kind of come and go. They get bet‐ ter. They get worse. Sub‐ stance use really does bring it on more as well."

Untreated psychosis can affect a person's prognosis, according to Rose.

"The longer individuals go without treatment, it can ac‐ tually do damage. It becomes more difficult for the brain to recover and to get the indi‐ vidual back at baseline."

The program runs week‐ days from 8:30 a.m. to 4:30 p.m. ET, but times often shifts to accommodate school or work schedules. Every Tuesday, at Windsor's Youth Wellness Hub, clients have opportunities to meet with their psychiatrist.