In THE SPOTLIGHT

Study Shows Promising Results for Early Treatment of First Episode Psychosis; Funding Mechanism Needed to Ensure Comprehensive Service Delivery

By April Banerjee, Program Manager for Public Awareness and Education

“Untreated psychosis increases a person’s risk for suicide, involuntary emergency care, and poor clinical outcomes. . . . Early intervention can alter this illness trajectory….” ¹

The American Journal of Psychiatry recently published encouraging results of a study funded by the National Institute of Mental Health (NIMH) as part of an effort to develop approaches to promote symptomatic and functional recovery for first-episode psychosis. ²  The study was part of NIMH’s Recovery After an Initial Schizophrenia Episode (RAISE) initiative.

The RAISE Early Treatment Program (RAISE-ETP) was a randomized controlled trial that included 404 individuals between the ages of 15-40 years at 34 community mental health treatment centers in 21 states.  The ETP used a coordinated specialty care treatment approach called “NAVIGATE,” which included four elements: 1) personalized medication management, 2) family education and support, 3) individual therapy that emphasized resilience training, and 4) supported education and employment.  These elements were offered and implemented within a framework that was more collaborative with the patient than traditional community care.

The study assessed each participant over a 2-year period.  The NAVIGATE participants experienced “significantly greater improvement” than the community care participants on a Quality of Life scale and “greater improvement” on the Positive and Negative Syndrome Scale (PANSS).  As a group, NAVIGATE participants also showed “significantly greater gains” in either working or going to school (as measured by the percentage of participants who either worked or went to school on any day per month). ³ The authors noted that it was unknown whether results were sustainable over time and reported that a follow-up study will continue the assessment for 5 years to “provide information on longer-term effects and optimal treatment duration.” ⁴

The median duration of untreated psychosis for the entire sample of study participants was 74 weeks, ⁵ which is more than six times longer than the World Health Organization’s standard for “effective early psychosis intervention.” ⁶  The study found that the NAVIGATE approach had a substantially greater benefit to participants who had a shorter duration of untreated psychosis.  Thus, the authors recommended that a major focus of applied research efforts should be on reducing the duration of untreated psychosis to less than 3 months. ⁷

The RAISE-ETP study not only improved functional outcomes for participants, it also demonstrated that this type of comprehensive specialty care for first-episode psychosis can be implemented by real-world community clinics in the US.  The authors noted that only some of the services provided by NAVIGATE were funded by insurance, so supplemental funding, e.g., for supported employment and education, is needed.

As reported in PWDF’s Fall 2014 e-newsletter, supported employment appears to provide mental health benefits for employees with mental disorders.  In that article, PWDF urged policymakers to increase the availability of supported employment for people with mental and/or developmental disabilities.  Three federal agencies recently published joint policy guidance to help states design a comprehensive benefit package using federal funds for early treatment intervention options for first episode psychosis, including supported employment and education services. ⁸ Of particular note: the Substance Abuse and Mental Health Services Administration (SAMHSA) Mental Health Block Grants (MHBGs) now require a 5% set-aside for evidence-based programs that provide early serious mental illness treatment.  Congress increased the MHBG allocation so that states could “meet this new requirement without losing funds for existing services.” ⁹ Other authors have also proposed a general financing model for early intervention of psychosis, noting that supportive employment is an example of an effective intervention that is adopted “very slowly.  It is not enough for innovators, clinicians, and policy makers to figure out a way to ‘cobble together’ funds to pay for demonstration programs.” ¹⁰

PWDF is heartened to see such promising results for early intervention treatment of psychosis and looks forward to seeing the results of the long-term studies.  We urge all states to begin providing or enhance existing services for early intervention, specifically incorporating supported employment and education in their benefit packages.  We also urge states to find workable sources of funds to ensure that all people who need it receive early intervention treatment for psychosis.

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People With Disabilities Foundation is an operating 501(c)(3) nonprofit organization based in San Francisco, California, which focuses on the rights of the mentally and developmentally disabled.

Services

Advocacy: PWDF advocates for Social Security claimant’s disability benefits in eight Bay Area counties. We also provide services in disability rights, on issues regarding returning to work, and in ADA consultations, including areas of employment, health care, and education, among others. There is representation before all levels of federal court and Administrative Law Judges. No one is declined due to their inability to pay, and we offer a sliding scale for attorney’s fees.

Education/Public Awareness: To help eliminate the stigma against people with mental disabilities in society, PWDF’s educational program organizes workshops and public seminars, provides guest speakers with backgrounds in mental health, and produces educational materials such as videos.

Continuing Education Provider: State Bar of California MCLE, California Board of Behavioral Sciences Continuing Education, and Commission of Rehabilitation Counselor Certification.