Hospitals & Services
Totara House is a specialist multidisciplinary service for young people (aged 18-30) who live in Christchurch (New Zealand) and are experiencing their first episode of psychosis. For those not living in Christchurch, contact your local GP, health centre, or mental health service.
Totara House is an "early intervention in psychosis" service. This means we treat people as early as possible in a psychotic episode and aim to assess people who may be showing early signs of developing psychosis.
Psychosis is a form of mental illness in which people have experienced difficulty with their thinking. This may result in abnormal beliefs, perceptions or thought processes. Further information on this is available in the section What is Psychosis.
Research and clinical experience show that the earlier the treatment, the better the outcome.
We provide a service to young people who experience their first episode of psychosis. They may be in the early stages of, or recovering from, a psychotic episode.
Our service is:
There is a strong emphasis on client empowerment and (where appropriate) family involvement.
We actively seek those who may be experiencing psychosis in order to reduce the duration of untreated psychosis.
Our early intervention programme aims to:
decrease the risk of further psychotic episodes
minimise the trauma of psychosis
reduce the likelihood of hospitalisation
The experience of psychosis can damage self esteem and increase anxiety. A person may withdraw from everyday activities, and become socially isolated. When this happens in adolescence, or young adulthood, it can be particularly devastating. It disrupts the process of normal development to healthy adulthood.
The Totara House programme therefore provides opportunities to:
learn techniques for managing psychotic symptoms
manage anxiety and stress
build on personal strengths
have fun and generally develop independent, adult, healthy life skills.
At Totara House we:
Identify and treat psychotic symptoms
Educate the person and their caregivers about psychosis
Reduce disruption to their life
Support the person and their caregivers during recovery
Reduce experiences such as depression, anxiety, and lack of motivation
Teach the client how to reduce their chances of having another psychotic experience
At Totara House treatment is provided through:
Multi disciplinary input
After the initial assessment the client is assigned a case manager - usually one of the team members who was present at the assessment. The case manager will co-ordinate care during the person's time at Totara House. The case manager has the role of ensuring that individual needs are met. This may include providing support, helping understand about psychosis, linking with other aspects of the programme, and helping access outside services where appropriate. During the first month or so, our staff will work together with the client, their family (if appropriate), and any one else considered important by the client, to develop a thorough assessment of needs and develop a "care plan".
The case manager will also discuss the "early warning signs" which indicate a person might be becoming unwell, in order to reduce the chances of this happening again. Once the client knows what to look out for, the client and their case manager can develop a personal plan or "Crisis Plan" so they are aware of what to do and who to contact in this situation. This is another technique to help the client feel more in control of their life.
Our group programme provides a variety of groups that are designed to meet the current needs of clients and help them get back on their feet. Groups which may be offered include:
Art from the May 2009 Art Therapy Group focusing on the Journey of Recovery
techniques to learn about and manage psychosis
social and recreational activities
art therapy group
family support group
Learning from each other, especially from peers, and discovering you are not alone, are great ways to move forward. Therefore we encourage participation in groups, which are a combination of fun, information, sharing, learning, and support.
When young people start behaving differently, or seem to be in some sort of emotional crisis, families are usually worried, have lots of questions, and want reassurance. They usually want information about psychosis, mood problems, diagnoses, and medications. Sometimes other close friends or support people find themselves with similar concerns. Often families have issues about independence, setting rules, how much alcohol is OK - the normal kinds of issues families grapple with.
Families may want different levels of involvement at different times, and Totara House will involve them as much or as little as the client and family want in planning an individual programme. Family sessions may be arranged by the case manager or social worker to explore some of these family issues.
Evening education and support sessions are available for family members and support people on both a time limited and ongoing basis.
A number of families meet regularly for sharing experiences, information and support, and have found this to be very worthwhile.
During the client's first few visits to Totara House they will be introduced to their doctor, who will work alongside them and the case manager to ensure their needs are met. The doctor is responsible for overall care in conjunction with the multidisciplinary team.
People with psychosis usually need medication as part of their treatment. It is likely that the doctor will prescribe medication and may arrange other medical investigations. These medications are fully discussed with clients. Many people who come to Totara House have questions and worries about the effects of taking medication, and we work hard to ensure that as much information as possible is made available. If the client has any concerns at all about medication, they are encouraged to discuss this fully with the doctor and case manager.
Recently a number of new medications have become available which are extremely effective in managing psychotic symptoms and have few side effects. When medication is prescribed, our philosophy is to use the lowest possible dose, and only for as long as required.
There is a lot of evidence that people recover more quickly from psychosis if they have psychological treatment as well as medical assistance. Psychological treatment aims to help people understand and re-evaluate the experiences they have when developing, during, or following psychosis. Understanding reduces fear and increases one's sense of control and independence. Most people will be offered group treatment, but many will also receive individual treatment when it seems like it might help. Psychological treatment can also be offered to assist with other difficulties such a low mood or anxiety which often occur after or during a psychosis.
Totara House staff come from many different backgrounds ( nursing, occupational therapy, social work, psychology, and psychiatry). This means case managers can draw on a wide range of experience and expertise when working with clients to develop an individual "Treatment Plan". If clients require specific expertise in any area their case manager can refer them or their caregivers to the team member with that specialist skill.
As part of our routine assessments and reviews, various rating scales are used. The results of these will be placed on clinical files to evaluate an individual's progress. They will also be used in a way which does not identify specific people to evaluate our service. This service evaluation may be published, but there is no way information could be linked to any individual. Evaluation of our service is also helped by the use of client, and family, satisfaction surveys.
From time to time we hope to conduct research projects within our service.
Participation in research is entirely voluntary.
Non participation will not affect treatment.
Clients will be fully informed of the nature of any research in which they are invited to participate.
Research results will be made available to participants.
Any research projects undertaken at Totara House have been approved by the Canterbury Ethics Committee.
Research will assist us in evolving a service which is responsive to our clients needs.
Illegal drugs, solvents, and alcohol are sometimes used because they seem to reduce stress and anxiety, alter mood, or help relieve psychotic symptoms. However, there is increasing evidence that alcohol and substance misuse can:
contribute to a psychotic episode,
worsen an existing psychosis,
interfere with recovery from psychosis.
For these reasons Totara House encourages:
Knowledge and understanding of the effects of alcohol and drugs on mental states.
Clients to stop or reduce their consumption of these substances.
An alcohol and substance free environment for clients.
Clients are not able to attend groups while intoxicated, and will be asked to leave the premises. If you have alcohol or illicit drugs at Totara House you will also be asked to leave and may be banned from the premises. Police action may be initiated under the Misuse of Drugs Act.
Totara House will not tolerate possession, use of, or dealing in alcohol or illicit drugs at Totara House or in the immediate vicinity.
Totara House is an outpatient programme. How long you choose to stay involved with the programme, and how frequently you attend will vary from person to person. Some people come several times each week, and may continue doing so if they are feeling particularly vulnerable and in need of a lot of support. Others may be studying or working and attend less frequently. Some may be involved in the programme for less than three months, but we generally anticipate that people will develop an ongoing relationship with Totara House for one to two years.
Many of the Totara House clients feel like this about coming to a new place or meeting new people. No problem! We are happy to come and talk with you at a safe place where you feel comfortable. This might be at home, at work, at a coffee bar, or some place else. After you get to know us a bit better and feel less anxious, we are confident you will feel OK about starting to come. We will fit in with whatever is best for you.
We have provision for 96 people on our case load at any one time. We are funded for people between the ages of 18 - 30, although the majority are between 19- 25.
If it is difficult for you attend, please discuss with your casemanager and we will try to make alternative arrangements. Please advise us as soon as possible of any difficulties so we can avoid delays in making another arrangement, and to minimise disruption to others.
The service is funded by the government as part of the Mental Health services provided by Canterbury District Health Board, and is free of charge. However, you may be asked to pay some nominal costs, such as for craft materials and social outings. If you are on a benefit or student allowance, your case manager will talk with you to make sure you are receiving all your entitlements.
This is often a difficult time for your family or support people, as they may have questions and feel they need support themselves. It may be helpful for us to be able to speak with them to understand fully what the difficulties are and how we can best be of help. If you feel strongly about this, please speak to your case manager.
Sometimes a person may experience another episode of psychosis. Once you and your case manager have worked out your crisis plan, you will feel more able to recognise warning signs and will know what you can do to cope. If you feel that you are becoming unwell you should tell your case manager or doctor immediately.
We usually work closely with GPs, counsellors, and others involved in your care so that we are all working together to provide you with the best possible co-ordinated treatment. We encourage every one to have a GP so there is at least one person we can communicate with who is aware of all your health needs. Any information given about your treatment will comply with the provisions of the Health Privacy Code and other relevant legislation.
During the hours of 8.30 am - 5.00 pm, Monday to Friday, you or your family can phone Totara House on Ph 377 9733 and ask to speak to your case manager or the Duty Person. In an after hours emergency, the Psychiatric Emergency Service (PES) is available, 7 days a week, on Ph: 364 0482.