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July 9, 2019

The Importance of Coordinated Care for First Episode Psychosis

Coordinated care is a whole person-centered approach to improving mental health outcomes that involves individuals who proactively collaborate across the spectrum of medical, psychosocial, emotional and therapeutic support, and it’s particularly pivotal in the treatment of early psychosis. In a 2017 study, researchers found that patients who received coordinated specialty care (CSC) saw education and employment rates increase from 40% to 80% by 6 months, hospitalization rates decrease from 70% to 10% by 3 months, and improvement in GAF scores continue for 12 months.

When dealing with possibly debilitating mental illnesses such as schizophrenia, schizoaffective disorder, major depression or bipolar disorder, there’s simply no overstating the impact coordinated care has on outcomes. With coordinated care, a college student is more likely to return to school, graduate, and go on to develop a career; without it, one may be more likely to withdraw from school and rely on disability to survive.

That’s just one aspect of outcomes, the benefits of coordinated care are myriad. And when clinicians involved in any part of a patient’s care do not communicate, and families are not educated, it quite certainly puts the patient’s health and quality of life in great jeopardy. There is no more critical time in the life of a patient diagnosed with schizophrenia or schizoaffective disorder than the first episode.

According to the National Institute of Mental Health (NIMH), in the United States, about 100,000 teenagers and young adults each year experience a first episode of psychosis, with peak onset between the ages of 15 and 25. While there are early signs of psychosis, typically a person suffering a psychotic episode sees, hears or feels things that aren’t there (hallucinations) or develops strong beliefs inconsistent with the person’s culture, and which are unlikely to be true and may seem irrational to others (delusions). When such hallucinations or delusions take hold, the person experiences a break from reality ? this is a psychotic episode.

With an average of 35.6% of 18- to 24-year-olds enrolled in college according to the last U.S. Census, that means many are college students at the time of a first episode. A student beginning to show symptoms might withdraw from friends and activities, hear disparaging voices, speak in a disorganized manner, or ignore hygiene.

Psychosis can be bewildering and terrifying for the sufferer as well as family and friends, but this is especially true for a first episode, let alone one that occurs in a social setting such as a college campus. If the wide range of ways psychosis presents is any indication, it’s not a wonder that it “takes a village” to help sufferers.

Unfortunately, at the time of a first episode, parents may feel so powerless to help that they take their child to the emergency room and teachers may become so frightened that they call the police. In short, psychotic episodes often devolve into crisis, but institutions that help during crisis are not designed to treat the whole of a complex mental illness such as schizophrenia. Usually, after stabilizing, the patient is discharged. At best, they are provided pamphlets about the most typical choices for next-step care ? inpatient hospitalization or an intensive outpatient program. Students miss so much school that they drop out or worse, are not allowed to return. A downward spiral begins.

“Preventing negative events like dropping out of school, losing the ability to work, and losing contact with friends and family also has the potential to reduce indirect costs to society,” the NIMH website notes. Further, coordinated care following first episode psychosis is not only about helping people return to a path toward productive, independent lives, it could make the difference between life and death. According to Treatment Advocacy Center, “compared with the general population of all ages, the mortality rate following first-episode psychosis was 89 times higher.” Jail, chronic illness and substance abuse are all prevalent consequences of lack of proper treatment as well.

According to the National Alliance on Mental Illness, coordinated specialty care consists of the following six key components:

• Case management – This overall approach helps people develop problem-solving skills, manage medications, and coordinate services.
• Psychotherapy – Sessions focus on personal resiliency and managing the condition, such as developing coping skills and focusing on self-care and wellness.
• Medication management –Antipsychotic medicines can work well, but it can take time to find the most effective medication at the most appropriate dose that the patient can adhere to over time.
• Supported education and employment – A psychotic experience often disrupts major life activities, so it is crucial to support the person’s ability to continue or return to school or work.
• Family support and education – Psychosis affects many others beyond just the person who experiences it, so it’s important for families to have the knowledge and skills to support treatment and recovery.
• Peer support – Given the stigma that still unfairly surrounds mental illness, connecting with others who have been through similar experiences can help the patient cope with the diagnosis.

These components are ingrained in our model of care at Hopewell. As a residential therapeutic farm community, we provide 24/7 life skills training, psychotherapy, medication management, meaningful work, family interaction and a peer community in a nurturing environment. By specializing in schizophrenia, schizoaffective disorder, major depression, and bipolar disorder, Hopewell is uniquely positioned to apply the type of coordinated care that can help a student cope with serious mental illness and return to college. The sooner someone who has experienced a first episode can receive coordinated care, the more likely they are to reduce symptoms and maintain quality of life.