Most Portage residents have had a complicated background of trauma, family dysfunction, and chaos – all factors that can lead to mental health problems, says Liz Graham, a nurse and the Coordinator of Health Services at Portage Elora. Staff are therefore constantly on the lookout for signs and symptoms of concurrent disorders of addiction and mental health issues.
“At Portage, we have an important window of opportunity where the youth are clean of illicit substances for at least four months and we can look at the possibility of mental health issues,” says Liz. “We can look for mood changes, reactive, or cyclical changes, knowing that they are not being caused by drugs, but perhaps by something else.”
All residents undergo comprehensive mental health assessments when they arrive at Portage and throughout their rehabilitation process by the nurses on staff and by the consulting psychiatrist. Through the BECK Depression Inventory Scale and the Crisis Intervention Assessment, residents answer a series of questions about altered mood, perceptual disturbances, hallucinations, and so on. Memory is also tested to see if the illicit drugs that the resident was taking have had any effect on memory function.
It is not uncommon for a young addict’s mental health issues to have arisen prior to his/her addiction issues and for that person to be using illicit drugs to self-medicate the underlying mental health issue. On the other hand, the illicit drugs that the person has used can also be the cause of memory loss, delusions, and paranoia, which themselves can trigger mental health issues.
To assess for mental health problems, Portage gathers as much background information on each resident as possible. A large focus is on the family profile, where they look for instances of early chaos. Did the resident have many figure heads? A single parent with many different father or mother figures? This may lead to attachment disorders. Were they traumatised by violence early in life? Were they abused or did they witness a parent being abused? This trauma can lead to extreme anxiety. Is there a history of mental health issues in the family? They may be genetic and/or they may have incapacitated the person to act as a parent to the resident.
Portage Elora’s consulting psychiatrist spends a day at the facility twice a month. She attempts to piece together a diagnosis based on all past and current assessments of the resident’s mental health. This diagnosis opens the door for Portage staff to more appropriately treat the resident and, where warranted, for the resident to be prescribed medicine to help regulate his/her mood. “The diagnosis does not necessarily lead to a cure, but at least it gives us the reason for the problem that we can use as a base to work from,” says Liz.
The psychiatrist makes specific treatment recommendations for clients to Portage staff and has started to provide workshops to help staff members better understand concurrent disorders.
The role of the consulting psychiatrist has become much more involved over the past ten years, as mental health problems and concurrent disorders have become more prevalent among youth admitted to Portage Elora. The psychiatrist studies each case specifically and individually rather than on the widespread therapeutic community level, as was done in the past. She also ensures the continuum of services when a resident leaves Portage, with referrals to outside mental health and addiction counseling for those clients that need it.
Throughout the assessment and treatment process at Portage, residents come to understand that there is no quick fix to addictions or mental health. They learn that it takes time and effort to change their behaviour, their moods, and their perceptual problems. At Portage, they are given the tools and the opportunity to develop the skills they need to work at it.