Nurse-led Psycho-education Program for People With First-onset Mental Illness (APN-PEP)
Nurse-led Psycho-education Program for People With First-onset Mental Illness (APN-PEP)
The study aims to test the effectiveness of a nurse-led psycho-education program based on
 motivational interviewing technique for Chinese patients with first-onset mental illness over
 a 12-month follow-up. A randomized controlled trial will be conducted with 180 Chinese
 patients with schizophrenia newly referred to one outpatient clinic in Hong Kong. They will
 be randomly assigned to either the eight-session nurse-led psycho-education program or usual
 psychiatric outpatient care (both n=90). The patients' general and mental health, illness
 insight, self-efficacy, services utilization, and hospitalization rates were measured at
 recruitment and one week, six months and 12 months post-intervention.

 Note: Those who were approached in the clinic and not eligible to participate in this trial
 will be invited to participate in another controlled trial. The controlled trial tests the
 effects of a self-help problem-solving based bibliotherapy program (SPBB) for Chinese family
 caregivers in recent onset psychosis (not more than 1 year onset) at one psychiatric clinic,
 in comparison to routine outpatient service and family support (control group) for 116
 randomly selected family caregivers of outpatients with psychotic disorders over a 6-month
 follow-up.)
The development of APNs in Hong Kong is in line with nursing development internationally.
 Since 2001, the Hospital Authority has appointed about 530 nurses as APNs, in whom about 50
 are in mental health practice. Five of these psychiatric APNs function independently and
 interdependently with other health care team members to excel to health educators and care
 coordinators with fulfilments in health assessment, education and care coordination for
 clients with noticeable mental health problems, being referred to psychiatric outpatient
 service. A structured one-to-one psycho-education program has been developed and trial run to
 provide early psychiatric and psychosocial intervention and support to the clients who have
 been triaged by the psychiatric nurses in two outpatient clinics in the Kowloon East Cluster
 as categorised as those who present noticeable mental symptoms but low risks of self-harm or
 violence. These clients are arranged to have their first psychiatrist consultation in the
 clinic within two to eight weeks following triage. Prior to the consultation appointment,
 they are referred to the psychiatric APN in the nurse-led clinic for providing further
 psychosocial health assessment and early intervention and psychological support. As estimated
 by the clinic staff, there are 60% of the clients (i.e. 60 cases per month) triaged and
 classified as such category in the two outpatient clinics.

 This study aims to evaluate the effectiveness of the one-to-one, nurse-led psycho-education
 program provided by the psychiatric APN for those newly referred clients with mental health
 problems on improving their mental and emotional conditions, quality of life, and
 satisfaction with service, and on reducing their rates of hospitalization and default
 follow-up in two psychiatric outpatient clinics (OPD) in Kowloon East region of Hong Kong.

 Objectives of the study

 1. To investigate the effects of the nurse-led psycho-education program for newly referred
 clients with mental health problems triaged as Category 2 on improving their mental
 state, anxiety state, insight and treatment attitude, self-efficacy in life situations,
 general health, and utilisation of and satisfaction with mental health care services
 provided over a period of 12 months follow-up; and

 2. To investigate the effects of the nurse-led psycho-education program on reducing the
 clients' rate of hospitalization and default follow-up in the psychiatric OPD over the
 12-month follow-up.

 [Note: Those are not eligible to participate in this trial will be assessed by an Advanced
 Practice Nurse to join the randomised controlled trial with repeated measures, parallel-group
 (2-arm) design will be carried out at one psychiatric clinic. This pilot trial aims to
 evaluate the effects between the treatment group (i.e., a problem-solving based self-learning
 program, SPBB) and routine outpatient service (control group) for 116 randomly selected
 family caregivers of outpatients with recent-onset psychosis over a 6-month follow-up. The
 study outcomes include the caregivers' burden of care, caregiving experiences, and
 problem-solving abilities, and the patients' mental state, functioning, and
 re-hospitalization rates. They will be measured at recruitment, one week, and 6 months
 following the interventions. Objectives of the study are: 1. To investigate the effects of
 the SPBB program for family caregivers of recent onset psychosis on improving their
 caregivers' burden of care, caregiving experiences, and problem-solving abilities, and the
 patients' mental state, and functioning over a period of 6 months follow-up; and 2. To
 investigate the effects of the SPBB program on reducing the clients' rate of hospitalization
 and default follow-ups in the psychiatric outpatient clinic over the 6-month follow-up.
Inclusion Criteria:

 -  aged 18-60 years, able to understand Cantonese/Mandarin;

 -  having the first-onset of the mental illness (psychotic and mood disorders) within the
 past six months and new referral or contact with mental healthcare services;

 -  presenting at least moderate to high levels of psychiatric symptoms (i.e., Brief
 Psychiatric Rating Scale score of >25 out of 126 and/or Chinese version of the Beck's
 Depression Inventory-II scores of >10 out of 63); and

 -  indicating no history and low risk of suicide and self-harm.

 Exclusion Criteria:

 -  receiving other psychosocial interventions organized by the clinics or other
 healthcare organizations; and

 -  being classified as the highest priority of psychiatric consultation and treatment
 (i.e., starting their treatment and care plan with their attending psychiatrist and
 clinic nurse within one week).

 [Note: For SPBB study, the inclusion Criteria of the participants include those who are:
 Hong Kong Chinese residents, aged 18-64; taking care of and living with a family member
 primarily diagnosed with one psychotic disorder in the past 12 months psychosis will be
 recruited; able to read and understand Cantonese/Mandarin; and perceived a moderate to high
 burden of care (measured by Family Burden Interview Schedule (>20 out of 50 scores).
 Exclusion criteria of family caregivers include those: received or are receiving another
 family intervention; are having cognitive impairment or learning disability; and/or
 presented with a recent personal history of a serious mental illness or medical disease
 that may adversely affect their ability to participate in the intervention.]