Reality Check – What to Expect?

Serena: [00:00:00] Welcome to the reality check psychosis is real. So is recovery podcast.

Ashley: I'm Dr. Ashley Weiss. I'm a child adolescent psychiatrist

Serena: and I'm Serena Chaudry. I'm a clinical social worker

Ashley: and we are the co founders of Epic NOLA, which is the early psychosis intervention clinic in new Orleans and also the co founders of calm clear answers to Louisiana mental health.

Today. We are going to talk a little bit about what to expect. Expect. When you walk in the front doors of the clinic on your first day, which is a really important moment for us because we're waiting for you. We really know that showing up is the first step and it's a hard

Serena: step.

Ashley: It's a hard

Serena: first step when your world sort of been turned upside down and you've experienced this disconnect from reality.

And a lot of times that disconnect [00:01:00] lands people in the hospital or in a really uncomfortable place. And so I do think it's important for people to know that there's a team of people waiting and wanting to help you make sense of what's just happened. And to create a roadmap for your recovery,

Ashley: just the clinic itself.

I think it's important to know that it's pretty comfortable and people are pretty nice. Ty is our, helps us out of the front of the house and she's wonderful and all of our patients love her. So the whole idea is to have a, a welcoming, comfortable environment. And so when people are coming, they might be coming for the first time to see their therapist and meet their therapist, or they might be coming to see their psychiatrist for the first time.

So we usually don't do two things in one day because That would be very overwhelming, but, but one, so give us Serena, the low down on a [00:02:00] first appointment with your. Soon to be psychotherapist.

Serena: All right, so on your first day with your psychotherapist, it'll be a lot of time just being with them, sharing what you feel comfortable about, sharing in regards to your first episode of psychosis.

And if you don't feel like sharing, it'll be the therapist talking about where you've landed, helping to understand Epic NOLA and the different services that we provide on this multidisciplinary team. We've talked in a previous episode about how we provide medication management. Psychotherapy, um, family education, we have peers, people with lived experiences, we have a, uh, wellness coach, and so your therapist will talk to you a little bit about these different services, and listen, to what you're willing and able to share during that first [00:03:00] appointment.

And, you know, when I see people for the first time, it's really about as much or as little as they are willing to do or share. We really try and meet you where you're at and understand that the road to recovery is looks really different for everyone. And it can move at whatever pace you're able to move at.

So it's about a, you know, 45 minute to an hour appointment that first time. And we like to ask people to come into therapy weekly, at least for the first couple of months so that we can get a sense of you, you can get a sense of us and we can really better understand what just happened and most importantly, try and prevent it from happening again.

And so you'll see a therapist, as we said, on one day, and then on another day, you get to see your psychiatrist. And what happens

Ashley: then? So the psychiatric [00:04:00] evaluation sounds like way more intense than it actually is. Our goal is to, to learn about your history, especially your medical history. Because as physicians, we're not only concerned about your Mental health, but also your physical health and to make sure that you're that you're healthy and all on all fronts So there'll be a lot of kind of boring questions that we ask about your history of allergies or history of medications, history of being in the hospital, family, biological history of either mental illness and, and physical illness.

But then the fun part, I feel like, is asking you a lot about your experiences growing up, your experiences in school, your experiences with friends, your experiences with your family, what you like to do, your hobbies, and kind of just like getting to know you as a [00:05:00] person. And then also, you know, wanting to know the more difficult things that might have gone on in your life that could be affecting you in this moment, aside from the psychosis.

So, you know, we'll talk in depth about how psychosis started for you, even if we're not necessarily using that word at that given time, but like sort of what is your story about this? Event that has happened that now has evolved and landed with a referral to our clinic and really try to like normalize that story for you and, and help you better understand and kind of process what's going on.

And so kind of putting together the bigger picture is. Are there symptoms happening that you want resolved? Can medication play a role in reducing symptoms and helping someone feel less stressed, less distressed, sleep better, feel less anxious, feel less depressed, [00:06:00] feel more energetic? You know, where can we intervene with medications that could kind of get you feeling back to your usual self?

I'm making those decisions and it's a shared decision. It's not a forced treatment type of situation. And so we. We'll go through those options with you. We might order laboratory work to check for other issues going on. Like make sure your thyroid's healthy. Make sure your vitamin levels are good. Make sure your organs are functioning well.

Um, and then we also talk about, you know, treatment goals and treatment goals of medication. What you would like medications to be integrated into your life, or if you don't want them into integrated into your life, and what are the risks? Risks of that. I think our psychiatrists are pretty straightforward with, um, giving the best opinion that they can give, but also respecting other people's opinions.

And they might have had bad [00:07:00] experiences with medications and we have to kind of address those experiences before we can come up with a new plan. And, and not all of the, you have a lot of patients that are happy with their meds. , we have a lot of stigma about psychiatric meds. Uh, I think. Maybe I'm just lucky to know many psychiatrists that want to figure out how to integrate it into your life and not, like, make you feel like it's forced or making you feel bad in some way.

It's certainly not my goal. And we talk about what the clinic has to offer and integrating, like, what therapy, what you can expect from therapy, what you can expect from the groups. And we figure out how to ease you into the clinic in a way that works best. I also think I definitely stress that it's a journey and that, you know, coming to see us on a regular basis isn't because we think anything's necessarily wrong with you because this process takes time and treatment takes time and the more we're comfortable with each other, the better we [00:08:00] can know what is like right for you and when you're starting to not feel like yourself and we're able to learn about those things.

Serena: Yeah, huge part of this, people being able to trust us and us being able to trust them. What would you say to someone who wants to reach out for help, wants to come to EPIC, but is feeling vulnerable? Fearful or uncomfortable taking that step

Ashley: and just revealing my catastrophic thinking, but what is worse that could happen?

The worst that could happen is you walk in the door and you're like, I don't like the color of paint on the walls and you leave or walk in the door and I don't feel comfortable. And then you leave. Or, hey, Dr. Weiss, thanks for trying, but I'm not interested right now. Because it's not a forced environment.

This isn't a court ordered environment. It's just not. I think trusting that we're able to sit with material and with content that might seem out of the ordinary. You know, that [00:09:00] the only thing emergent, For us as doctors, as therapists, the emergencies are when truly feel that you're in danger, you know, that, and we can't prevent it.

So, you know, there's this active plan to hurt yourself. Active plan to hurt someone else where we can't even negotiate another plan. Like that's when things become more of an emergency talking about unusual things, talking about hearing voices. It's not an emergency. It's an experience. And I think some people are worried that they're going to say that.

And people are going to think like they're quote unquote crazy and then just hospitalized them. And I've had way too many patients where that has happened. That they mentioned that they hear voices and it's immediately met with, you got to go to the psychiatric hospital.

Serena: Yeah. Yeah. I think it's super important for people to know that our goal is to keep people out of the hospital.

We work as a [00:10:00] team really hard and to help you manage symptoms through medication, through therapy, so you don't have to go to the hospital unless it's, you know, absolutely necessary. And you're at risk of harming yourself or others.

Ashley: And I think to just like. I'm just kind of reflecting with you back on like recent hospitalizations, recent hospitalizations of patients.

It's been kind of a mutual decision, like where, where our people have said, Hey, I think I need to go to the hospital. Like I'm not,

Serena: I

Ashley: can't deal with this. You know, the hospital isn't necessarily the worst case scenario. A lot of our people over time will sometimes elect for that because they, they feel like they need some structure to kind of get back on track.

So don't want to, I don't want to be like, Oh, the hospital is the most horrible place in the planet, but like that it is an option for treatment, an [00:11:00] outpatient clinic who aims to keep people out of the hospital. However, if that becomes an option, then it's like, Sometimes it's mutually agreed upon,

Serena: right, right.

And I think it is really powerful when people are at a point in their recovery, where they can, where they realize that a hospital might be the, a good place to be for a while. And they make that decision themselves, right? That feels very different than being forced to go to the hospital

Ashley: and having that experience of being forced, especially with, for our people, Serena, it feels like they, they I don't want to give out a percentage, but we've had the experience where people have tried to reach out or they've tried to share this unusual experience with someone and the, the person that they're sharing it with just for whatever the reason is kind of resorts to like calling the police or going to this optic [00:12:00] as drastic measure.

And that can really be a hindrance. to try and get help again, because that's the experience.

Serena: Mm hmm.

Ashley: Yeah. Some of the things I always think about when people do get to our clinic is if that has happened to them before, and how we're going to have to, you know, Negotiate that with them and help them to see or have a different kind of experience with treatment to where that that's their safe place to share these things.

And I'm, you know, speaking of, like, the 1st, 2nd, 3rd psychiatric visit, all of us are trying to come up with, like. What is your safety plan? I mean, of course we need to have a safety plan. I think I need to add you as my emergency contacts. One of my emergency contacts, I feel like I always know where you are, even though we're in the different ends of the country, but what are, what is, what is an emergency and what's not an emergency?

And a lot of what we do really isn't an emergency when we're treating psychosis. [00:13:00] Yeah. We're just

Serena: trying to help support people sort of live better. Their best lives and do what they want to do. As young adults, so I'm excited to have some of our patients on and tell their stories and talk about what it was like to come to the clinic on the first day and maybe some of the things that were uncomfortable or scary for them and how they overcame that and have stuck with us for a while.

Ashley: Yeah, for sure. First step. It's always the hardest, but we want it to feel comfortable, even though it's challenging. And we recognize that it's challenging. And. I have mad respect for people that take that chance to chat with us. All right. Well, that was awesome. Talk. It's good to see you. Of course,

Serena: as

Ashley: always, until next time, thanks for taking the time to get your reality check.

And remember, psychosis is real. So is recovery. If you have enjoyed this episode or found it useful, [00:14:00] please subscribe wherever you get your podcasts from and check out the website, calm NOLA. org.