STEP program focuses on early intervention for young people with psychosis

Jan. 23--NEW HAVEN -- Dr. Vinod Srihari, and his colleagues at the Connecticut Mental Health Center, are offering a program, free of charge, for young adults experiencing symptoms of psychosis that has been shown to keep them out of the hospital and back on track with their careers or school work.

A combination of medication and therapy, the Specialized Treatment Early in Psychosis (STEP) clinic has been offering comprehensive care since 2006 for patients, mainly in their late teens or early 20s when schizophrenia and related disorders usually manifest. Another important component is the involvement of their caregivers in the treatment.

Srihari and state, local and medical officials gathered at The Grove Thursday, kicking off a media campaign called Mindmap, to educate the public on how common serious mental illness is and how the key to effective treatment is early intervention.

The clinic expects to take in about 100 patients from the region, covering Bethany, Orange, Woodbridge, Hamden, New Haven, West Haven and East Haven, as part of a multi-year, $3.5 million research grant from the National Institutes of Health and more than $250,000 from the state Department of Mental Health & Addiction Services that funds CMHC in a partnership with the Yale Medical School.

This program will be in effect for two years without regard to insurance coverage, Srihari said. The goal would be to transition those patients back to mainstream care. He said DMHAS is commited in the long haul to continue the program at the mental health center.

Srihari said the model they are using was successful in the United Kingdom, Australia and Northern Europe and has been adapted for a public sector community center in the U.S. to provide early intervention for this age group where brain development is still taking place.

He wanted a model of care that could easily be adapted at other mental health centers, which they hope to do after more research is finished.

"When you intervene early and the brain is plastic, that is a special moment that you can effect the entire course of that person's life. ... This program is pretty darn unique in terms of programs available in the country," said Dr. Michael J. Sernyak Jr., CEO of the mental health center and a researcher on brain development..

The public information blitz will be make heavy use of social media to try to reach parents and those suffering from the delusional thinking associated with schizophrenia and bipolar disease, where symptoms usually appear between the ages of 16 and 25, with 85 percent of cases occuring under the age of 35.

Srihari said patients so far have been recommended by other clinicians, but they hope the media campaign will draw them from a wider net.

The Mindmap materials said the media exaggerates the link between mental illness and criminal violence and said schizophrenics are 14 times more likely to be the victim of violence than the cause of it.

"The reality is, violence is more closely linked to alcohol and drug misuse in those with and without mental illness," according to the material.

In a random study of 120 individuals who had experienced their first episode of psychosis, Srihari said half received treatment at the STEP clinic and half were referred to community providers based on their insurance coverage.

A total of 75 percent of patients in STEP avoided hospitalization in the next year to about half for the other group. Patients in STEP were also more likely to be back in school or actively seeking employment.

Tomas Reyes, chief of staff to New Haven Mayor Toni Harp, said the STEP program will fit in with the type of programs the city is offering as part of its youth department.

Ben Florsheim represented U.S. Sen. Chris Murphy, D-Conn., who could not attend, but who continues to hold roundtable discussions around the state on the need for more accessible mental health programs, particularly in light of several mass killings in the U.S. in recent years.

Florsheim talked about STEP in context of the 26 schoolchildren and educators killed by Adam Lanza in Newtown in 2013.

Referring to a recent report on Lanza, Florsheim said the lone gunman had multiple interactions with the mental health system, "but it was always too little, too late."

"The point of making sure folks are aware that treatment is available, that treatement is out there, that treatment is effective is the goal of this project obviously and something that needs to be re-emphasized on the national level," Florsheim said.

State Rep. Patricia Dillon, D-92, a longtime elected official working to get money for mental health programs, said often bewildered families can't agree that a child needs treatment and she cited cases in which mentally ill individuals then end up in the criminal justice system after acting out.

She said this age group is in a tough place in terms of their own denial and their families' denial. This can be compounded when a university expells a student for his or her behavior and they then lose their health insurance.

"There is a human cost, because there is so much pain. There is a social cost, it disrupts our communities. ... It is wonderful to be here to see people who are trying to develop hopeful strategies for solving this issue," Dillon said.

Srihari didn't feel he was in a position to talk about the Lanza case, but said generically, "the challenge of getting young people not just to go to care but stick with care is a very considerable one and it is not a simple problem to solve. ... It is a very complicated web."

The STEP program puts a heavy emphasis on support for the family and returning the patient "to vocational training or college or to work. It's a package that helps a young person get back on track," he said.

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