IT USED to be that young people who developed mental problems got into difficulties in school or with the police before ending up in the mental hospital.

These days, the problem signs are more likely to be picked up by teachers and counsellors.

The difference is a pilot programme started by the Institute of Mental Health (IMH) in 2001 to identify early those who show signs of psychosis and treat them.

People with psychosis have a mental illness where they lose touch with reality, becoming, say, suspicious. When it becomes more extreme, it is called schizophrenia.

Under the Early Psychosis Intervention Programme (Epip), hundreds of teachers and counsellors were trained on the symptoms to look out for, such as lack of motivation and apathy or hallucination and delusion.

IMH staff also gave talks to students at universities, polytechnics, junior colleges and institutes of technical studies, and plastered these places with posters of the illness and its symptoms - and the fact that help is at hand.

As a result, teachers, parents and family doctors are able to spot the problem early and get help.

Patients now get spotted about four months after the first symptoms appear - down from an average of one year previously.

So far, 1,100 people have been treated under the programme - without a single one needing long-term hospital care.

The Ministry of Health will expand the programme and gradually raise its funding to $2.5 million a year by 2011.

Once a student with mental problems has been identified, the school can call up a case manager and discuss symptoms.

The student then gets an appointment with an IMH psychiatrist and follows up with treatment. He gets a semester off school to recuperate if necessary.

During that semester off, the student may attend activities like pottery, exercise sessions, social skills training and vocational coaching to keep them active.

Since most are on the verge of entering the job market, they are also taught how to write resumes and do well in interviews.

While schizophrenia cannot be cured, medication can control the symptoms so the patient can continue functioning normally and live in society.

But about 5-10 per cent of patients are drug-resistant and nothing helps. Most of the long-term inmates at IMH suffer from schizophrenia.

Over the years, Epip has become more cost-effective.

In its first year, the disease cost patients $127,602 a year, of which about $4,600 was for medication and treatment and the remaining $123,000 was money lost from not being able to work.

In the second year, the cost fell to $95,856. Money lost from not being to work dropped dramatically to $90,000. The difference is that patients were well enough to return to work.

IMH is also working with the armed forces to identify national servicemen who show early signs of psychosis, since they are at the age when the disease first hits.

IMH research head Associate Professor Chong Siow Ann said the institute is also conducting several large-scale studies on side effects of medication.

Associate Professor Richard Keefe of the Duke University Medical Centre, who works closely with Prof Chong on some of the IMH research projects, said the programmes are 'known throughout the world for its efficiency and patient care'.

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