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Part 4 - Early Intervention in Mood and Anxiety Disorders: The First Episode Mood and Anxiety Program (FEMAP)

This is part 4 of a 4 part blog series about research done at the First Episode Mood and Anxiety Program (FEMAP) at London Health Sciences Centre (LHSC). FEMAP is a program helping older teens and young adults with emotional concerns which fall into the categories of mood and/or anxiety symptoms. They provide a safe and confidential place for youth to get help early, before symptoms begin to disrupt lives. Research at FEMAP is conducted by researchers at Lawson Health Research Institute and Western University.

We’ve been writing this blog series about research done by FEMAP, but to wrap it up we thought we would cover an article based on what FEMAP itself is actually about. One of the main pillars of FEMAP is the emphasis on early intervention. For almost all other types of chronic and episodic illnesses (e.g. diabetes, chronic pain, heart disease, arthritis, multiple sclerosis, and cancer), early intervention is the medical standard. However, in more recent years this model was also finally implemented within the mental health field through initiatives for early identification and intervention of psychosis. Because it was also known that mood and anxiety disorders are more responsive to treatment the earlier it is received, there was inspiration to develop an early intervention program for these disorders too. FEMAP was modelled based on the Prevention and Early Intervention Program for Psychoses (PEPP), also in London, Ontario. The characteristics of PEPP that were of interest to the founder of FEMAP, Dr. Elizabeth A. Osuch, were the ability to self-refer, the emphasis on accessible outpatient services, short wait times, and a focus on first episodes.

With funding from the department of psychiatry, donations, and research project funding, Dr. Osuch was able to expand FEMAP, and in 2009 it moved from its limited space in the hospital to a renovated house in the community. This meant FEMAP could have a home that was less stigmatizing and more accessible, welcoming, and youth-friendly.

In order to increase the probability that FEMAP patients could recover with the level of treatment available, using strict inclusion/exclusion criteria was key given the lack of resources. These criteria include: mood or anxiety symptoms as the primary problem; age 16-25; no developmental delay or severe learning disability; no primary substance use that began before mood/anxiety symptoms occurred; no major medical problems; no ongoing legal charges; and less than 18 months of being on psychiatric medication. Now to look at the actual program, Phase I involves community outreach, in-person intake assessment, and consequent recommendations for the youth (which would be one of three options: acceptance into FEMAP for treatment; referring the youth to a different program that would better serve them; or, more rare, reassuring the youth that they do not require specialty mental healthcare). Phase II involves full psychiatric or psychological evaluation, treatment, and recovery from illness. Two identified possible long-term outcomes are: sustained recovery from illness or eventual recurrence of illness requiring episodic care/ lack of remission and the need for ongoing care. Due to the nature of mood and anxiety disorders, it is very possible that some youth will experience repeated episodes of illness or chronic illness.

Evaluation of Phase I has indicated that the outreach was effective and was attracting mostly appropriate youth (in the early evaluation, 73% of youth who contacted FEMAP were suited for and accepted into the program after screening and assessment, and newer data reflects that this number has increased to 85%). A brief cost effectiveness review indicated that effective, early outpatient treatment of youth with mood/anxiety disorders is a much more efficient investment of social funds compared to neglecting to treat these illnesses early on and paying the longer-term consequences e.g. ER visits, hospitalization, or social assistance.

FEMAP has experienced challenges along the way, such as providing care for many patient groups that it was not designed for because otherwise those youth would have gone untreated. Another challenge revolves around rapid response, in which FEMAP hoped to maintain but has not been able to due to demand. Without extra funding for more resources and thus no way to hire more clinical staff, wait times have increased from two weeks to over five months - a wait that FEMAP feels is unacceptable for an early intervention program. Overall there have been many lessons learned and hopefully FEMAP can continue making its positive impact on our community.

To find out more about FEMAP, you can visit their website here, and if you’re interested in reading more about some of the lessons or evaluations, you can find the reference information below:

Osuch E A, Vingilis E, Fisman S, Summerhurst C. 2016. Early intervention in mood and anxiety disorders: The first episode mood and anxiety program (FEMAP) Healthcare Quarterly 18: S42-49 Crossref, Medline, Google Scholar.