Early Interventions
for Psychosis

First Episodes and High-Risk Populations

_____

Alexandra Andrada, Sharyl J. Nass,
and Joe Alper, Rapporteurs

Forum on Mental Health and
Substance Use Disorders

Board on Health Care Services

Board on Health Sciences Policy

Health and Medicine Division

Proceedings of a Workshop

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW, Washington, DC 20001

This activity was supported by Purchase Order No. 75FCMC22P0038 with the Centers for Medicare & Medicaid Services and Contract No. HHSN263201800029I, Order No. HHSN26300025 with the National Institutes of Health (National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Mental Health), and by the American College of Clinical Pharmacy, American Psychiatric Nurses Association, American Psychiatric Association, American Psychological Association, Centers for Disease Control and Prevention, Council on Social Work Education, Janssen Research & Development, LLC, National Academy of Medicine, Office of the Assistant Secretary for Planning and Evaluation, Think Bigger Do Good Policy Series (a partnership of the Scattergood Foundation, Peg’s Foundation, Patrick P. Lee Foundation, and Peter & Elizabeth Tower Foundation), U.S. Department of Veterans Affairs, and Well Being Trust. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number—13: 978-0-309-69760-6
International Standard Book Number—10: 0-309-69760-3
Digital Object Identifier: https://doi.org/10.17226/26832

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Early interventions for psychosis: First episodes and high-risk populations: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26832.

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PLANNING COMMITTEE FOR A WORKSHOP ON EARLY INTERVENTIONS FOR PSYCHOSIS: FIRST EPISODES AND HIGH-RISK POPULATIONS¹

DOST ÖNGÜR (Cochair), Chief, Psychotic Disorders Division, McLean Hospital; William P. and Henry B. Test Professor of Psychiatry, Harvard Medical School

RUTH SHIM (Cochair), Associate Dean of Diverse and Inclusive Education, Director of Cultural Psychiatry, and the Luke & Grace Kim Professor in Cultural Psychiatry, University of California—Davis

DEANNA BARCH, Chair and Professor of Psychological and Brain Sciences, Washington University in St. Louis

JOHN MICHAEL KANE, Professor and Chairman, The Donald and Barbara Zucker School of Medicine at Hoffstra/Northwell; Northwell Health, Zucker Hillside Hospital

KATHY PHAM, Director of Policy and Professional Affairs, American College of Clinical Pharmacy

KRISTINA D. WEST, Social Science Analyst, Office of Behavioral Health, Disability, and Aging Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services

Project Staff

ALEXANDRA ANDRADA, Director, Forum on Mental Health and Substance Use Disorders and Program Officer

LAURENE GRAIG, Senior Program Officer (Acting Forum Director May–October 2022)

ADRIENNE FORMENTOS, Research Associate (Until May 2022)

ANESIA WILKS, Senior Program Assistant

SHARYL J. NASS, Director, Board on Health Care Services

Consultant

JOE ALPER, Consulting Writer

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

FORUM ON MENTAL HEALTH AND SUBSTANCE USE DISORDERS¹

MARGARITA ALEGRÍA (Cochair), Harvard Medical School

ROSALIE L. PACULA (Cochair), University of Southern California

ERIN BAGALMAN, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services

KIRSTEN BERONIO, Centers for Medicare & Medicaid Services

CARLOS BLANCO, National Institute on Drug Abuse, National Institutes of Health

CARLA M. CANUSO, Janssen Research and Development, LLC

CHRIS M. CROWE, U.S. Department of Veterans Affairs

W. PERRY DICKINSON, University of Colorado (Representing the American Board of Family Medicine)

ANTHONY T. ESTREET, Morgan State University (Representing the Council on Social Work Education)

RICHARD G. FRANK, Brookings Institute

HOWARD H. GOLDMAN, University of Maryland School of Medicine

ROBERT K. HEINSSEN, National Institute of Mental Health, National Institutes of Health

KRISTIN KROEGER, American Psychiatric Association

JAN L. LOSBY, Centers for Disease Control and Prevention

R. KATHRYN MCHUGH, Harvard Medical School and Mclean Hospital (Representing the American Psychological Association)

BENJAMIN MILLER, Well Being Trust

ANNIE PETERS, National Association of Addiction Treatment Providers

KATHY PHAM, American College of Clinical Pharmacy

JOE PYLE, Scattergood Foundation (Representing Think Bigger Do Good Policy Series)

DEIDRA ROACH, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health

MARY ROARY, Substance Abuse and Mental Health Services Administration

GLORINDA SEGAY, Indian Health Service

RUTH SHIM, University of California—Davis

MATTHEW TIERNEY, University of California—San Francisco, School of Nursing (Representing the American Psychiatric Nurses Association)

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by ALAN F. SCHATZBERG, Stanford University School of Medicine. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

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Acknowledgments

The National Academies of Sciences, Engineering, and Medicine’s Forum on Mental Health and Substance Use Disorders wishes to express its sincere gratitude to the planning committee co-chairs Dost Öngür and Ruth Shim for their valuable contributions to the development and organization of this workshop. The forum wishes to thank all the members of the planning committee, who collaborated to ensure a workshop complete with informative presentations and rich discussions. Finally, the forum wants to thank the speakers and moderators, who generously shared their expertise and their time with workshop participants. Support from the many sponsors of the Forum on Mental Health and Substance Use Disorders is critical to its work. The sponsors include the Centers for Medicare & Medicaid Services, the National Institutes of Health (National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institute of Mental Health) and the American College of Clinical Pharmacy, American Psychiatric Nurses Association, American Psychiatric Association, American Psychological Association, Centers for Disease Control and Prevention, Council on Social Work Education, Janssen Research & Development, LLC, National Academy of Medicine, Office of the Assistant Secretary for Planning and Evaluation, Think Bigger Do Good Policy Series (a partnership of the Scattergood Foundation, Peg’s Foundation, Patrick P. Lee Foundation, and Peter & Elizabeth Tower Foundation), U.S. Department of Veterans Affairs, and Well Being Trust.

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Contents

BOXES AND FIGURES

ACRONYMS AND ABBREVIATIONS

PROCEEDINGS OF A WORKSHOP

OVERVIEW OF THE WORKSHOP

IDENTIFYING POPULATIONS AT RISK FOR PSYCHOSIS AND INTERVENTIONS TO REDUCE RISK

EARLY INTERVENTIONS FOR FIRST EPISODES OF PSYCHOSIS

The Epidemiology and Social Patterning of Psychosis

Online Screening for Mental Health

Discussion

CURRENT MODELS OF CARE

Team-Based Model for Collaborative Care

New Journeys Program of Washington State and Pathways to Care

Strengths of CSC in California and Challenges to Growth

OnTrackNY

Discussion

EVIDENCE ON SHORT- AND LONG-TERM OUTCOMES

Five-Year Outcome Data from the RAISE Early Treatment Program

Racial Analysis of Social Determinants of Psychosis: A Better Frame for Unmet Needs?

State Mental Health Agency Support for CSC Programs and Use of the Federal Mental Health Block Grant 10 Percent Set-Aside

Discussion

EXPLORING POLICY OPPORTUNITIES

SAMHSA’S ROLE IN FIRST-EPISODE PSYCHOSIS

Community Programs for Outreach and Intervention with Youth and Young Adults Through the Clinical High Risk for Psychosis Grant Program

Expanding, Improving, and Sustaining Early-Psychosis Services in the United States

Advocacy for Improved Policies

Policy Futures

Discussion

CLOSING REMARKS

REFERENCES

APPENDIX A: STATEMENT OF TASK

APPENDIX B: WORKSHOP AGENDA

APPENDIX C: SPEAKER, MODERATOR, AND PLANNING COMMITTEE BIOGRAPHICAL SKETCHES

Boxes and Figures

BOXES

1 Key Observations Made by Individual Workshop Participants about Care for People with Early Psychosis

2 Suggestions for Future Research from Individual Workshop Participants

3 Suggestions Made by Individual Workshop Participants to Improve Care for People with Early Psychosis

FIGURES

1 Psychosis risk map by county based on MHA online screening results

2 Downstream and upstream factors that can produce health disparities and inequities in access to care

3 The coordinated specialty care approach of OnTrackNY

4 Components of the NAVIGATE CSC intervention used in the RAISE Trial

5 Hypothesized model of systemic racism and psychosis in the United States

6 Percent of CSC early-psychosis program clients experiencing adverse life events, before and after participation in the program

7 Self-perception of changes in well-being among CSC early-psychosis program participants

8 Number of coordinated specialty care programs for early psychosis by state, 2022

9 Coordinated specialty care models for early psychosis that states were using in 2021

10 Coordinated specialty care component use among early-psychosis programs

11 Use of standardized measures by CSC programs for early psychosis

Acronyms and Abbreviations