[MUSIC] There's no such thing as a good illness. All illnesses are uncomfortable, and they cause distress for families, as well as for the people who are sick. But mental illness is just a little bit different. It's a bully; it's a big bully. First, it isolates young people by whispering them away from their friends, then school and work, and finally even hobbies, sport. Anything that was once fun. It wants you at home, alone, in your room with your covers over your head or your nose in the computer. But mental illness is not done with that. It bullies families, takes away dreams, hopes, the aspirations that they once had for that son or that daughter. It teaches them to despair, finally, it affects the very institutions that are supposed and protect young people, the family unit, education, even health professionals, and that makes everyone feel like just giving up. Recovery in mental illness means finding ways to build wrap around care and connections so that we can revitalize these systems. And bring these young people back into their families, back into education and back into their communities so that they can move forward in their lives. And that we, as a community, don't miss out on what they have to offer to the world that we live in. Despite the significant burden of mental illness it's very hard for people to access the range of medical and psychosocial interventions that have been demonstrated to promote recovery and reduce this social disability. The YES project is a PhD study with the University of Sydney. It's designed to show young people, their families and schools that there is a way to deal with this silent bully. By building a wrap around model of care that includes and protects social networks and structures, illness progression can be pushed out. Young people can recover, they can stay engaged with their communities, they can complete their education. They can move forward in their lives. When you have a mental illness, it doesn't have to be your life, it can be managed. If young people are given an opportunity and the environment to, not only learn these skills, but be somewhere where they can practice them. That way mental illness doesn't manage them. We used a three prong attack: medication to stabilize the condition, psycho-education about the mental illness itself, and then an environment in which to practice these strategies so that self management just became a habit, and the young person didn't have to think about it anymore. To do this, they had to understand the mechanics of their illness. How did their illness affect them? What were their symptoms? How could they manage these symptoms? In effect, we wanted to teach the young person how to become their own early intervention team. So, what did we do? Well, around 133 young people were randomized into two groups. So it was a social participation group, which included Anxious Art and eHealth Lounge, and a physical wellbeing which consisted of tennis and cardio boxing. All participants got to participate in all of the activities, but they didn't get to pick the order in which they did the activities. So the idea was that young people went to school in the morning because in this way we could manage their sleep wake cycle. They got up, they got dressed, they had a place to go, and then in the afternoon they would come to us at the clinic and participate in this research. So the programs themselves are dynamic. They're not about talking, they're about doing. Anxious Art was held at the National Art School in Darlinghurst where we had a big beautiful studio to work in. The classes themselves were run by a well-known and respected artist, Linda Bohm. And they were real classes, so they're not special classes for these kids. They were the same art classes as everybody else did at the National Art School, we talked about philosophy, we talked about politics, we talked about modern art. And they were exposed to all these ideas, and what these ideas look like. Well, they had an academic framework around them, and like I said, the students were treated like other students at the college. The idea was not how to become an artist. This was about putting young people in an environment that they did not know, that they weren't familiar with, and making them work in a medium that they didn't understand and they probably didn't even like. And in this way, we could teach them illness management, positive social skills, how to listen and how to work with criticism, how to use shared spaces, and challenge the idea, importantly for many of these students, that there is a world outside of the school system and they can in fact be part of it. And importantly, we wanted to see, once they learned these skills, could they keep these skills and then transfer them to that high school system. The same is true for tennis and cardio boxing. This is not about training to become an athlete, it's about showing young people the role of exercise in general health, and its impact on the sleep wake cycle. Again, it targets pro social skills. It teaches muscle memory and sequential thinking and improves spatial abilities. Many of them, for the very first time, had to learn to anticipate where things were in space like a tennis ball, and then be able to hit it. About half way through the group session we would take a break. Now, the kids called this the teacup talks, because we would set up a table cloth, we'd drink real tea, out of real cups, have biscuits, and we'd talk about different mental health topics. The most important part of these talks, I think, was that it included families. So this presented an opportunity for young people and for families to develop an understanding of the role of lifestyle in managing mental illness, as well as discussing some of the latest research in mental illness. So the topics that we dealt with included goal setting, the sleep wake cycle, what is it? How does it work? What role does it play in your mood? Seasonal adjustments, how does that affect your sleep? The role of routine and structure, medications, diet, exercise, as well as brain training. Now this is actually called cognitive remediation, and a lot of young people who suffer from mental illness they have a lot difficulties with concentration, with focus, with recalling information. And so that makes school really, really difficult for them. And these games that you play actually target those areas of your brain, and strengthen those areas. We spent a lot of time, learning and using those games. We looked at the research on MRI scanning, which the kids are completely fascinated by, and depression and metabolic abnormalities. What are they? How do you get them? How can you fix them? And how can you improve your overall health so that you enjoy health for the rest of your life? And the talks were very, very popular by, not only the families that attended, but also often by the schools that attended as well. They lasted for about a half an hour. And one of the things that we tried to do with all the young people that we worked with was give them an eHealth toolbox which was what they had on their mobile phone. Now, this was supported by different mental health apps. Some of them were to manage distress, some of them were to teach them about their sleep and to monitor their sleep. So there's a variety of different apps that we used, and the idea was that if you were in a situation or in environment where you felt like you weren't coping or you felt like your illness was running up over the top of you, the coping strategy was to go to your phone. If you used these apps which are in themselves educational, that was just money for jam. So and this was a very, very popular resource to give to young people, because it's anonymous, it's private, it gives them something to do, they're on their phone and so they're busy. And that, in itself, is a very sort of soothing thing to be able to do in a variety of different social settings, including school. Now the companion piece to the eHealth toolbox was wherever it was possible, we actually encourage families to get the young person a dog. Now dog walking is a fantastically social thing, and it also includes exercise and being outside. And in this way, we could teach young people how to regulate their brain clocks. So we're trying to encourage social participation, and of course, having to take your dog to walk in your local neighborhood, does exactly that. So what is really nice to show in a study about preserving social function, and how do make this impact? Well, at the beginning of the study, on average, participants were spending 10 days out of every month in bed. And they were unable to carry out at their usual activities for 16 days of that month. 56% of the cohort rarely attended school at all and the rest had very, very patchy attendance. For those who completed both arms of the program, by the end of the year, the average participant had 12 days of reduced activity due to illness. One year later, this had reduced to 6 days, which indicates that they had kept some of the practices that they had learned in the study. They had gone forward in their lives, and they were more engaged with their communities. Importantly, they're spending less time in bed. At the end of the program, they were spending 5 days out of the month in bed, and a year later only 3. So this is a significant improvement of where they were, if you're looking in terms of social engagement, in lifting that social function. This is a significant improvement in how young people are dealing with their lives. At the end of the study 80% of the participants had completed their HSC. They had their year 12, they had an ATAR, and they were going to university or they were going to TAFE. This is a wonderful, unexpected result, and one that makes a huge impact, not only for these young people, but also for their families. And, again, for you and I, for the community that we live in. These young people are now contributing to our society. This is Anxious Art, and the students are at work in our studio, they're preparing to work with a semi clad model. Which is really a nice way of saying somebody who doesn't have very many clothes on. As one of the students said to me afterwards, Jeanne, do you know how hard it is to study someone when you have anxiety, to really look at them? So you can see that it's very challenging exercises for young people with a mental illness, even though in terms of art, it's quite a simple, straight forward project. For those young people, that completed the research project, they all said, much like this young person did, that they learned how to see outside of their own heads. That just because they thought it, it didn't necessarily mean that it was true. That mental illness was a force, and it could be managed. It was not the only source of information, and they could look past it and they could see it in context. Like one of my colleagues said to me the other day, you know, Jeanne, you make this sound like magic, but actually it's science. [MUSIC]
