Early Intervention Programs and Their Role in Recovery
By Everly Groves, NAMI Policy Intern and Jessica Hart, NAMI State Advocacy Manager
What if there were effective services available to help with outcomes of schizophrenia and early episodes of psychosis? There are some exciting early intervention programs emerging to do just that. NAMI partnered with the National Council for Behavioral Health to host a webinar (or view the presentation slides) highlighting the importance of early intervention in psychosis and how it can improve people’s recovery. The webinar was sponsored by the National Association of State Mental Health Program Directors as part of the Substance Abuse and Mental Health Services Administration (SAMHSA) Technical Assistance Coalition.
NIMH RAISE Program
The National Institiute of Mental Health (NIMH) began the RAISE (Recovery After an Initial Schizophrenia Episode) program after looking over the growing body of international research that shows the effectiveness of early intervention in psychosis. Individuals who went through these international programs were more responsive to treatment and more likely to achieve social, educational and career success. The RAISE services were designed after this evidence-based research with the focus of altering the course of Schizophrenia by providing aggressive treatment as soon as possible. The early findings suggest that this program is very promising.
RAISE focuses on community outreach and engagement. The coordinated care concentrates on several layers, including low-dose antipsychotic medications, cognitive and behavior psychotherapy, family education and support, and educational and vocational rehabilitation. Providers work with individuals through a shared decision-making process. Shared decision-making processes are services that are put together with input from the individuals and their care managers.
NIMH granted funds to Dr. Lisa Dixon at the Research Foundation for Mental Hygiene at Columbia University and Dr. John Kane at Feinstein Institute for Medical Research in order to answer if the RAISE program could be widely implemented in the U.S.
The San Francisco, California-based PREP (Prevention and Recovery in Early Psychosis) Program's goal is to provide comprehensive treatment to people living with symptoms of psychosis. PREP services include a combination of early detection, rigorous diagnosis, supported employment and an array of science-based treatments. PREP reaches out to people that have a higher risk for developing Schizophrenia. The program provides psychosocial therapy and medication if the individual has developed Schizophrenia already.
Does PREP work? In short: yes. Here are some of the key results:
- Hospitalizations were decreased by 71 percent.
- Hospitalization days decreased by 73 percent.
- Emergency room visits decreased by 77 percent.
- $15,450 was saved per participant year.
- 38 percent of clients were enrolled in school or participating in employment at the first assessment.
- 54 percent of clients were enrolled in school or participating in employment at the second assessment.
View more results from PREP.
Can states afford to do these early intervention programs?
In 2014, Congress directed SAMHSA to require states to set aside 5 percent of their Mental Health Block Grant (MHBG) allocations to support “evidence-based programs that address the needs of people with early serious mental illness, including psychotic disorders.” In response SAMHSA, working closely with NIMH, issued guidance to states for implementing this requirement. NIMH also provided several suggestions (starting at page 14) for states that have limited funding.
What is NAMI’s role in bringing early intervention programs to local communities?
Darcy Gruttadaro, director of the Child & Adolescent Action Center at NAMI, and Dr. Ken Duckworth, medical director at NAMI, spoke about NAMI’s role in advocating for the coordinated array of services necessary to address a first episode of psychosis. This includes advocating for funding and building the mental health workforce. They also spoke about the importance of NAMI’s role as a family education and support organization in local communities. NAMI provides several programs, such as NAMI Parents & Teachers Allies, NAMI Ending the Silence, and NAMI On Campus that make NAMI uniquely positioned to reach schools.
What can you do?
Based on the evidence-based research, early intervention for psychosis is critical. It is critical to start treatment early. It is important to start engaging the community and making these programs available. Connect with your local NAMI to help advocate for these promising programs in your local community.
Look for upcoming blogs featuring local NAMIs who are doing great work in early intervention.