Early Psychosis Programs – taking it to scale

Early psychosis programs began about 20 years ago in Melbourne Australia led by a psychiatrist who observed data showing that there was an incredibly greater recovery rate among those people with schizophrenia who were first seen within a few months after the onset of psychosis.

Their program demonstrated that for that population they were able to achieve a success rate of 80% being discharged from the intensive treatment program to medication only after 18 months and full time employment or education as compared to a success rate of only about 20% for people for whom treatment is delayed for more than a year after the initial experience of psychosis.

This success has generally been replicated in other programs. Until recently, nearly all such programs were small “pilot” programs including about a dozen funded by the MHSA in California.

That is all about to change primarily due to the inclusion of a five percent set aside for these programs in the federal mental health block grant. In California that has resulted in an implementation strategy requiring every county that did not have a program to start one and for every county that has one already to expand it.

A conference was held by the University of California at Davis last week which attracted over 200 people including representatives of 32 counties including 26 of the 32 largest representing 90% of the state’s population.

At that conference Oregon reported that they had already taken the program to scale with sufficient sites to cover all new likely cases in the state. Here is their presentation from the conference.

In conversation with presenter Ryan Melton I learned that all participants are 25 or younger and 70% have Medicaid – which is the main funding source.

In reviewing the data from Oregon it is noted that half of the people were in school or work at the time of enrollment- indicating that they are generally reaching people who have not yet become completely disabled as nearly all seem to be upon entering other public mental health system programs.

Oregon also reports that the program is proving to save money from reduced hospitalizations with a hospitalization and re-hospitalization rate under 5% for graduates of the program.

Several CCCMHA member agencies already participate in the pilot programs in California led by the Felton Institute which is participating in several Bay Area programs.

With this new federal planning funding and knowledge and interest among counties there will be significant new opportunities for members throughout the state.

The opportunities could include agencies not only in the service delivery but in doing the outreach -generally outside of the mental health system targeted to the primary age group of 15-26 year olds among whom there is approximately one new case every month for every 10,000 people ( as compared to the general population for which there is about one new case a year among 10,000 people).

Once treatment begins the program must be one just for this population as mixing this group with people who are more disabled and less likely to respond as quickly to treatment has been proven to diminish the success of the program and staff needs to be specially trained.

General national information about the state of research and analysis of these programs is included and referenced in this presentation from NIMH lead researcher Robert Heinssen and their program RA1SE.

The California Mental Health Services Oversight and Accountability Commission is also working on a study of the twelve initial MHSA programs that should be completed some time in 2016.

All of this information is valuable in developing best practices and cost effective strategies for both the outreach and the treatment in these programs.

Once taken to scale these programs should significantly reduce the number of people who experience frequent hospitalizations or long term disability due to delays in treatment of schizophrenia. That will achieve two of the main goals of the MHSA which is to make prevention and early intervention more of a norm and also to facilitate greater recovery for more people with mental illnesses. In achieving these goals it will also free up funds to serve a greater number of people and move us toward the biggest goal which is to be able to provide everyone with the level of service they need.
September 25, 2015

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