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Caring for young people's mental health at PRIME

June 08, 2021
by Clayton Simses

By now it’s no secret that teenagers and young adults have been hard hit by the COVID-19 pandemic. Many have reported an increase in mental health struggles, declining interest in school, social isolation and loneliness. Mental health care has been difficult to find as community-based providers are overwhelmed and often not accepting new patients.

Fortunately, for clients at the PRIME Clinic based at Connecticut Mental Health Center, care has not been compromised. Since adding telehealth one year ago, the clinic reports an astounding 69% increase in client participation in treatment.

“Some things are better done in person, but the numbers don’t lie,” says Barbara C. Walsh, PhD, PRIME’s Clinical Coordinator and a psychologist in the Yale Department of Psychiatry. “If we can deliver treatment in an effective way that reduces our patients' stress, telehealth is an excellent option.”

PRIME (Psychosis Risk Syndrome Clinic) provides preventative care for young people ages 12-25 who are at risk of developing psychosis. The clinic works with patients in the “prodromal” phase, a period before the onset of a psychotic disorder known as “frank” psychosis. PRIME uses the SIPS assessment (Structured Interview for Psychosis-risk Syndromes), a gold-standard diagnostic instrument in which the clinician assesses a young person’s risk for psychotic illness. PRIME’s clinical staff will even conduct the SIPS two-hour interview for young people outside of Connecticut and help refer them to appropriate providers in their area. (For more information on PRIME’s origin and mission, click here.)

Dr. Walsh and her team aren’t sure of the reasons for the increase in treatment participation, but they have some theories, all related to stress reduction. Eliminating the burden of transportation has meant families do not have to travel to New Haven from around the state. This change alone alleviates stress for parents, and thus for their children. Young people receiving treatment are more comfortable at home in their own personal spaces. And in the beginning, stepping away from in-person school was a positive experience for most PRIME clients.

“We saw a dip in our patients’ stress when schools initially went remote,” says Dr. Walsh. “In fact, we had to redefine what remission looks like because their symptoms came down so much.”

The story keeps changing, though. Now the prolonged COVID-19 pandemic has become very challenging for PRIME clients.

“The stress ebbs and flows,” observes Dr. Walsh. “It’s different for each person.”

PRIME clients have increased vulnerability to stress. Because stress is a driver of psychotic illness, reducing stress in the lives of clients and families is one of PRIME’s main goals.

“Stress is a very big portion of the psycho-education piece of the treatment,” explains Dr. Walsh. “We help patients identify their triggers and teach them how to manage their stress.”

Dr. Walsh emphasizes the importance of personal time and effective communication skills to combat the increased stress vulnerability. “The last thing a parent wants to hear from me is to let their kid play video games,” she laughs, “but sometimes fifteen minutes of escape allows the patient to recoup.”

The PRIME team helps the adults in their clients’ lives, mainly parents and teachers, develop their communication skills. Dr. Walsh’s advice is useful for anyone with a young person in their life: be conscious of tone and word selection when communicating with young people.

“If I say, ‘you should do your homework,’ it implies that the patient is doing something wrong,” she explains. “But if we set clear expectations about what needs to happen and by when, we can be empowering.” Enabling young people to make choices helps them gain confidence in themselves and prepares them for the future. PRIME provides clients with a toolbox of coping techniques; parents reinforce the positive tools at home, with the goal of enabling their children to live independently when they grow up.

PRIME’s community outreach program has also successfully shifted to an online platform. Before the pandemic, Dr. Walsh traveled to schools, mental health clinics, universities, and private practices to educate her audience on the early warning signs of psychosis.

“Now, instead of going out, I host ‘Lunch and Learns’ on Zoom,” comments Dr. Walsh. “I invite professionals to join our call and make them aware of the PRIME Clinic as a source of diagnostic clarification, treatment, and research studies.”

PRIME maintains a toll-free number for referrals (866-287-7463). Prospective patients, doctors, parents, education workers, or therapists are encouraged to contact the clinic if they know someone who might be eligible for care. Common symptoms include magical thinking, paranoia, drop in academic or social functioning, and disorganized communication. In recent weeks, perhaps reflecting the continued toll of the COVID-19 pandemic on young people, PRIME has been receiving a growing number of referrals. The good news: with more patients comes more opportunities for PRIME to help young people and their families.

Submitted by Lucile Bruce on June 04, 2021