Starting an Early Psychosis Treatment Program in the US: Catching up with the rest of the world?

Psychotic illnesses exert a devastating personal, societal, and economic burden under current systems of care across the world. The peak age of onset for psychosis during late adolescence and young adulthood can be particularly disruptive at multiple levels of life trajectory. The intuitively compelling notion of intervening earlier and therefore more effectively in the course of these illnesses has been demonstrated by several early intervention studies in other countries showing favorable clinical and functional outcomes. Several barriers in the current mental health care system have inhibited such an effort in the United States: a) the public-private sector divide, b) mental health care for adolescents and young adults is overseen by separate agencies in several states, thereby fragmenting potential interventions aimed at the peak ages of onset of psychotic illnesses, and c) the division of public mental health care by geographic catchment area limits the collection of a critical mass of early psychosis patients around which to organize care. This paper presents preliminary data of a randomized control trial of specialized, phase-specific treatment program (STEP) for early psychosis compared to treatment as usual. Participants in STEP receive individual therapy and case management with an emphasis on community reintegration, Cognitive Behavioral Therapy, Multifamily Group Psychoeducation, and specialized pharmacological management. Research evaluations are conducted at baseline and every 6 months for up to 5 years. Data presented will be from 6 month follow-up and include symptom, social, functional, and service utilization outcomes. Early analyses favor STEP. Policy implications will be discussed.