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Treating psychosis early

Yale Medicine Magazine, 2016 - Spring


For those who think the current U.S. mental health care system passes muster, Joel Roberts proposes this question: “Do we tell a patient with stage 2 cancer to wait and come back when it’s stage 4?” When a mental illness led his college student son to the emergency room, Roberts, of Fairfield County, Conn., researched treatment options across the country. Roberts, whose name has been changed to protect his family’s privacy, found that most programs targeted patients in severe, prolonged crisis.

According to Vinod H. Srihari, M.D., associate professor of psychiatry, few people receive timely treatment after their first episode of psychosis. The reasons can include a combination of factors related to the patient or the family’s awareness of a need for care, how to access professional care, and a lack of youth-oriented services.

Srihari wants to change these norms. “Patients may lack insight into their need for treatment, or, as is common to many youth, make poor choices around seeking help,” he said. He believes that savvy marketing via mass and social media channels could help. Two teams at Yale and Harvard are testing this approach through a five-year clinical trial funded by the National Institutes of Health. The trial tests the ways in which patients are recruited: traditional referrals or a campaign that includes media messaging, professional outreach, and a rapid response to calls for help. In 2014, the trial’s baseline year, both teams recruited via tried-and-true referrals from mostly traditional clinical settings.

Harvard Medical School’s Prevention and Recovery in Early Psychosis clinic serves as the trial’s control and continues to recruit through referrals. At Yale, Srihari’s team emphasizes early detection through advertising—he hired a New Haven-based marketing firm, Red Rock Branding, to pitch a local awareness campaign on psychosis, a mental disorder that includes hallucinations, paranoia, and delusions.

The opportunity pushed Red Rock’s founder, Glen McDermott, and his team into uncharted territory. “Focusing on a small target population—100 of 400,000—that is confronting a confusing and sometimes scary set of experiences that are often stigmatized presents a communication challenge beyond the usual marketing strategy,” McDermott said. The campaign, called Mindmap, targets women and men ages 16 to 35 in the New Haven area who may suffer from psychosis.

In February 2015, the Red Rock team launched, a website with a quiz designed to assess symptoms of psychosis. Anyone who suspects they’re at risk can call for a free screening by professionals at Yale’s Specialized Treatment Early in Psychosis clinic. If they qualify, they can join the trial. McDermott collects metrics through the website, Facebook, and Twitter to determine how people arrive on the quiz page. When potential patients call for a phone assessment, the Yale team verifies which channel led them to the hotline. Recently Red Rock began hiring “Mindmap activists” to help refine and deliver the message, McDermott said. This cadre will share their own mental health journeys at events, write blog posts, and lead local workshops about psychosis.

Final results won’t be available for some time, but Srihari has noted a correlation. Since the campaign’s start, calls to the free screening hotline at Yale climbed to 150, a 65 percent increase over the baseline year. Of those evaluations, a total of 38 patients enrolled in treatment at STEP.

What excites Roberts, a volunteer advocate for Mindmap, is the campaign’s potential to reduce the stigma of psychosis. Roberts wants to rewind back to that dark night on the psychiatric ward with his son. “I wish he could have heard from doctors and nurses that these symptoms are normal for your illness,” he said. “What you are experiencing is normal, and you will get better.”

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