Early Intervention, My Friend

July 2018
By Barb Higman

Screen Shot Early InterventionI enjoy attending annual conferences. One is certain to talk with old friends, make new connections and exchange business cards, check in on progress being made in the mental health field, and eat well. Recently I attended the NAMI Michigan Conference at the Grand Traverse Resort and Spa. There, together with U-M professor emeritus Tom Powell, a current NAMI Washtenaw board member and a wise and trusted tribal elder, I caught up with Barb and Bill Lane from Brighton.

As some of you may remember, Barb was the office manager before me. It is hard to believe that I first met Barb over 13 years ago. I am glad to report the Lanes are doing well. Becky Ralls, a teacher with Transition Services at Washtenaw Intermediate School District, introduced herself to me and Tom. We were happy and pleased to see her again at the June meetings of Mental Health Matters and the NAMI Washtenaw board. I also bring you good tidings from a dear old friend, Early Intervention.

A refrain often heard at mental health gatherings is this: “Come back when you are really sick.” I am reminded of the tendonitis in my knee, which I ignored until it got so bad I couldn’t help but pay it attention. Had I intervened earlier, I could have saved myself weeks of agony. Although “wait and see” sometimes is a good strategy, symptoms of mental illness should always be given the attention, respect, understanding and care they deserve.

In 2008 the National Institute of Mental Health launched a research initiative commonly referred to as RAISE, which stands for Recovery After an Initial Schizophrenia Episode. They wanted to determine whether intervening when an individual first experiences difficulty with thoughts and perceptions leading to an inability to recognize what is real and what is not is a viable strategy.

What if it were possible to halt the progression of an illness characterized by ever-worsening episodes of psychosis and previously thought to require a six-month duration of symptoms before it could be diagnosed? (What a novel idea!) Regarding schizophrenia, the third edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM III), published in 1980 (there is now a DSM V), states that “A complete return to premorbid functioning is unusual — so rare, in fact, that some clinicians would question the diagnosis.”

It is often a seemingly insurmountable challenge to give up or modify beliefs that were learned as facts. Over the last few decades, however, a huge body of disciplined research has taught us that early intervention can be feasible and efficacious.

When the RAISE investigation began, Australia, Canada and Europe (countries with single-payer medical systems) had already developed and successfully implemented treatment programs for first episode psychosis. The initial RAISE results suggested that mental health providers across multiple disciplines in nonacademic environments can develop skills to engage and provide treatment for individuals in the early stages of psychotic illness.

In fact, the results were so promising that the question became not whether early intervention works, but how to implement and sustain early treatment programs in “real-world” community settings across the United States with reimbursement by currently available health care payment systems. Now that we know we can and should intervene early, let’s do it and do it well.

During a conference breakout session, Cathy Adams, a social worker and alcohol and drug counselor, reviewed current early intervention research and shared information about NAVIGATE, a nationally recognized model for the early treatment of first episode psychosis. Based on programs widely implemented in Australia, NAVIGATE recognizes the importance of supports and services beyond medication. It integrates the following components: individual resiliency training, peer support, family psychoeducation, supported employment/education and medication management. Cathy concluded her presentation by embracing NAMI’s goal that every young person experiencing (or at risk of experiencing) psychosis should have access to quality first episode psychosis care.

Psychosis seldom emerges out of the blue. Please be mindful and get help if you observe subtle behavioral changes in the following areas:

  • Worrisome drop in grades or job performance
  • New trouble thinking clearly
  • Suspiciousness or uneasiness with others
  • Decline in self-care or personal hygiene
  • Spending more time alone than usual
  • Increased sensitivity to sights or sounds
  • Mistaking noises for voices
  • Unusual or overly intense new ideas
  • Strange new feelings or having no feelings at all

We have come a long way since the era when the late Carol and Jerry Rees, founding members of NAMI Washtenaw, sat in a session with a psychiatrist who did not speak until he showed them the door when their time was up. Although there is so much more to be done, I am hopeful there will be a time when mental illness is a thing of the past.

Cathy Adams is clinical director of ETCH (Early Treatment & Cognitive Health), 4572 South Hagadorn Road, Suite 1E, East Lansing, MI 48823. Contact her at 517-481-4800 or www.etchwellness.org.

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