New program reduces hospitalizations for youth with psychosis

Providing coordinated care to young people who experience their first psychotic episode reduces hospitalization costs and helps patients continue to work and go to school, according to a new study scheduled to appear online Feb. 2 in the journal Psychiatric Services.

If implemented nationally, the new model, designed in collaboration between Yale University and the Connecticut Department of Mental Health and Addiction Services (DMHAS), can significantly reduce the suffering, disability, and financial costs of schizophrenia and related disorders, according to the authors of the study.

“The model is a pragmatic, effective and economically feasible approach to early psychosis and one that is feasible to implement in real-world U.S. settings,” said Vinod Srihari, associate professor of psychiatry at Yale and lead author of the study.

Yale faculty modified international models to create the Specialized Treatment Early in Psychosis or (STEP) clinic, which provides comprehensive care for early psychosis patients and their caregivers. The first episode of psychosis often occurs in the late teens or early 20s so clinicians need to adapt treatments to meet the needs of this population, the authors say. The patient is assigned to a team that coordinates medication, counseling, and social skills training, as well as education of family members.

The study randomly allocated 120 individuals who met criteria for first-episode psychosis to receive care at the STEP clinic or a referral to community providers based on their insurance coverage. Three out of four in STEP care avoided hospitalization in the next year, compared to about half in the control group. Also, patients in STEP were more likely to be in school, have jobs, or actively be seeking employment than those in usual systems of care.

The STEP clinic is based at the Connecticut Mental Health Center (CMHC), which is a public-academic partnership between Yale and DMHAS. The authors believe this is an optimal model for the delivery of care and innovative new services and can work in many areas of the country.

The STEP program on Jan. 22 launched a campaign called Mindmap designed to increase availability of services in towns surrounding New Haven.

“Age-appropriate, client-centered care based on research that has proven to be effective is of the utmost importance,” said Pat Rehmer, DMHAS commissioner. “These types of intervention can be vital to recovery.”

“The message is simple: Treatment is available, effective, and the earlier, the better,” Srihari said.

For more information on the Mindmap campaign, visit the Department of Psychiatry website.