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Kelly Foss

When symptoms of psychosis first appear in teenagers, families often know something is wrong.

But finding answers and support can take months or even years.

That’s a challenge the Faculty of Medicine’s Dr. Zachary Giovannini-Green is working to better understand.Through research methods that include interviews with clients, family members and care providers, he’s been piecing together a comprehensive picture of how young people move through the mental health care system, and where the system falls short.

“Psychotic disorders are one of the most challenging and disabling disorders in psychiatry,” he said. “The longer a person remains in untreated psychosis, the more negative effect it has on their brain. If they remain in psychosis long enough, those effects are permanent.”

Pattern of delay

That’s why one of Dr. Giovannini-Green’s most striking findings is how frequently young people experience diagnosis delays, even after reaching out multiple times for help.

“You hear the same story over and over again,” he said, describing a pattern where families seek help from family physicians or specialists early but initial treatments are ineffective or incorrect and symptoms persist.

“This is a very difficult time for teens,” he added. “They are already trying to find out who they are and balancing dependence and independence, so if they seek help the first or second time and feel they aren’t getting much help, they aren’t going back for a third or fourth time. This is often when youth refuse treatment and manage their symptoms themselves using recreational substances like alcohol and cannabis.”

In many cases, symptoms worsen until they reach a crisis point, leading to hospitalization followed by a discharge.

Dr. Giovannini-Green says the process will often repeat itself several times before a psychiatrist makes an official diagnosis.

“It becomes a cycle. It is estimated that the period between first visit and diagnosis can be up to a year or even 18 months, in some cases.”

That delay can have long-term consequences for both the individual and for the broader system as untreated illnesses can lead to complex challenges beyond health care. It becomes a housing issue, an employment issue, a social skills issue and it becomes a criminal justice issue, he says.

“Families are also impacted. If you have a person who lives with a psychotic disorder, oftentimes they have to have a caregiver, so that person is taken out of the system, as well.’’

Early intervention

A key takeaway from his research is the importance of early identification and intervention.

He says if intervention is possible in an earlier phase, then the associated costs of treating a person who has a high-intensity illness that requires high-intensity and wraparound comprehensive care from multiple government departments can be prevented.

“[Individuals with psychotic disorders] are your friends and neighbours and are far more likely to be a danger to themselves than anybody else.”— Dr. Zachary Giovannini-Green

Dr. Giovannini-Green points to successful international models, such as the open dialogue approach, that emphasize early, community-based care delivered by a specialized team of professionals, including a psychiatrist, psychiatric nurse and social worker.

“They perform a home visit and sit down with the client and their support people to make an individualized support and treatment plan,” he said.

Research has shown strong outcomes for this model, including decreases in the need for antipsychotic medications, intensive inpatient hospitalizations, relapses and suicides.

“The results speak for themselves.”

Persistent stigma

Beyond clinical care, Dr. Giovannini-Green’s research highlights a persistent barrier of stigma and misunderstanding.

“The only information many people have about psychotic disorders is what they see on TV,” he said. “These are very extreme, very misleading examples not in line with the facts. The vast majority of people live relatively functional lives. They are your friends and neighbours and are far more likely to be a danger to themselves than anybody else.”

While Dr. Giovannini-Green’s research highlights gaps in care, he is also focused on solutions.

He is currently working with partners to develop a high school program aimed at helping youth recognize early warning signs and seek support.

Ultimately, he hopes increasing awareness will lead to earlier intervention and better outcomes.

Interested in learning more? Read about Dr. Giovannini-Green’s research, which was recently published in