All throughout #MentalHealthMonth, NAMI Keystone Pennsylvania is sharing helpful Q&A’s on various subjects. This week’s topic is First Episode Psychosis. Vicki Fetterman and Marci Sturgeon-Rusiewicz, who lead ENGAGE in Allegheny County, provided this overview.
Q: What is First Episode Psychosis?
First episode psychosis is the first time that someone experiences psychotic symptoms or a psychotic episode. Basically it is the time when a person first starts to lose contact with reality and finds it very distressing. Psychosis can include hearing, seeing, feeling, or smelling something that is not real, or can include paranoia or delusions such as believing in something that is not real.
Q: Explain ENGAGE?
ENGAGE stands for Educate, Navigate, Grow and Get Empowered and is a Coordinated Specialty Care Team (CSC) that is specially trained to work with individuals who are experiencing their first episode of psychosis. We follow a treatment model called Cognitive Therapy for Recovery (CT-R) which is very interactive and client centered. Basically, our job is to help our clients achieve the lives they always hoped for; including living, learning, working, and socializing in their own chosen environments while engaging in the activities that they enjoy.
Q: Why is identifying early psychosis so important?
Research shows that the longer someone experiences psychosis without treatment, (referred to as DUP or Duration of Untreated Psychosis) damage to the brain can occur. If people are connected to specialized treatment with a DUP that is about a year or less, it is possible to prevent permanent damage from occurring. Use of specialized treatment also decreases the likelihood of experiencing a second psychotic episode.
Q: Describe all of the people involved in an “FEP Team.”
As mentioned above, an FEP Team is referred to as a Coordinated Specialty Care team (CSC). Our team includes a psychiatrist, therapist, resilience and family support specialist, a case manager and a certified peer specialist. The team is led by a Team Leader who helps to coordinate members of the team and direct daily functions of the CSC. The team Leader is also initially responsible for community education and outreach. In addition, the Team leader accepts all referrals, schedules initial assessments and evaluation. The team functions together with the client in an effort to help meet the client’s needs and support them in achieving their identified goals. Each member of the team is specially trained in CT-R and delivers the treatment—not just the therapist. The treatment modality is rather an approach that is slightly adapted to each team role as opposed to a “therapy only” approach.
Q: If an individual thinks that they would benefit from an FEP Program, or if a parent believes their child may benefit, what steps can they take?
It is important for family members to keep an eye out for warning signs which can include hearing, seeing or believing things that others do not; persistent, unusual thoughts; strong and inappropriate emotions or no emotions at all (flat affect); withdrawing from family and friends (social isolation); a sudden decline in self-care; or trouble thinking clearly. After identifying warning signs, parents can reach out to the ENGAGE program to schedule an in-person screen where the Team Leader or Program Manager will meet them anywhere in the community. This initial screening can involve anyone the referred client would like to include in their treatment to discuss what they have been experiencing (ie: friend, confidant, family member, clinical staff or other support provider). If, after the screening and observational session is complete and it seems that the person is presently or has recently experienced psychosis, the youth or young adult is then scheduled to meet with the prescriber, who is a child and adolescent psychiatrist. This appointment is scheduled within two weeks. At that time, a formal psychiatric evaluation determines whether it is the client’s first episode of psychosis. If all of the criteria are met, (diagnosis, duration of psychosis, age and county) the individual is then introduced to the services and open to the program. This includes how ENGAGE operates, the suggested frequency of engagement with the team, and the approaches that are taken to support the client. Ultimately, the program is completely voluntary and the identified client must be agreeable to personally consent to the program.