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Mindmap Reduced Duration of Untreated Psychosis in the New Haven Area

February 02, 2022
by Christopher Gardner

A half-decade ago, you couldn’t drive or walk through New Haven without seeing the distinctive yellow Mindmap logo plastered on the side of a bus or on a billboard, emblazoned on a T-shirt or across a movie screen, or on a sign at a community event.

Mindmap was everywhere, and people in the city and neighboring communities were taking notice and wanting to learn more.

The highly visible public education campaign to promote early detection and treatment of psychosis in young people in Greater New Haven was having monumental success not only reaching potential clients but quickly getting them into care.

By the time the four-year grant-funded effort ended in January 2019, Mindmap was able to cut in half the overall duration of untreated psychosis in its 10-town catchment area.

A new paper published in Schizophrenia Bulletin Open tracks the success of Mindmap, which was launched in 2015 by the Specialized Treatment Early in Psychosis (STEP) clinic at the Connecticut Mental Health Center (CMHC) in collaboration with Yale School of Medicine and the Connecticut Department of Mental Health and Addiction Services (DMHAS).

“Mindmap’s success is due to the efforts of many – who we will now inform and thank as we plan our next initiatives,” said Vinod Srihari, MD, professor of psychiatry at Yale School of Medicine and director of STEP and Mindmap. “Large clinical and research teams at two early intervention services hosted this project, but it took the efforts of many community stakeholders to reduce delay.”

Mindmap used media messaging – social media, traditional media, and swag like T-shirts and coffee mugs – to promote early detection of psychosis. The campaign was based on a national effort in Norway called TIPS which promoted awareness of schizophrenia and urged people to talk about it.

Thomas McGlashan, MD, professor emeritus of psychiatry at Yale School of Medicine, was one of the early principal investigators of TIPS and consulted with Srihari and colleagues when the Mindmap project was conceived in 2014.

Mindmap’s clinicians worked collaboratively with partners at area high schools and colleges, religious communities, police departments, primary care centers, the judicial system, social welfare system, government leaders, and more to promote the program and disseminate information to young people. To qualify, patients had to be 16-35 years old and within three years of their first episode of psychosis.

STEP and Mindmap used a comprehensive system of customized care for people who called or visited CMHC to seek treatment. Teams coordinated medication and counseled patients and helped them with their social skills and to obtain jobs. In most cases, families were involved in treatment.

Eligible patients received care for two years at no cost, regardless of insurance. Patients who were considered “high risk” for psychosis but had not yet experienced their first episode were referred to another care clinic at CMHC.

Organizers say the results were an unqualified success, resulting in the first controlled demonstration of the reduction of untreated psychosis in the United States.

Mindmap recruited 171 patients at STEP and another 75 to a control site known as the PREP clinic based at the Harvard-affiliated Massachusetts Mental Health Center in Boston. Median total duration of untreated psychosis fell from 311.5 days to 149 days or from 44.5 weeks to 21 weeks.

Essentially, through its intensive outreach in the Greater New Haven area, Mindmap got more people experiencing first episodes of psychosis into treatment faster.

“We are grateful to the schoolteachers, college counselors, community clinicians, police officers, jail diversion staff, ambulance staff, emergency room and inpatient clinicians, community organization staff, advocacy groups, and many, many others who heard the campaign message and helped us rapidly shepherd individuals and families into care at STEP,” Srihari said.

John H. Krystal, MD, chair of the Yale Department of Psychiatry, said Mindmap is a great example of how Yale can increase the impact of its work with partnerships with the surrounding community.

“It is wonderful to see the Mindmap project move forward,” he said. “Its work is so important for patients and families dealing with psychosis.”

Srihari emphasized that Mindmap, funded by a grant from the National Institutes of Health, could not have achieved success without so many people’s hard work.

A local marketing firm, Red Rock, and its founder and CEO, Glen McDermott, developed the messaging and branding that enabled Mindmap to quickly achieve recognition in the community.

The two-site investigative team was led by Srihari at Yale and Drs. Matcheri Keshavan and Larry Seidman at Harvard, and members are listed as co-authors in the highly cited protocol (Srihari et al BMC Psychiatry 2014) and this core results paper (Srihari et al, Schizophrenia Bulletin Open 2022), both made available in open-access formats online.

The STEP team included clinical team leaders (Jessica Pollard and Shannon Imetovski), primary clinicians (Josina James, Carrie Veillette, Laura Yoviene Sykes), psychiatrists (Walter Mathis, John Cahill, Keith Gallagher) and multiple generations of psychiatry and psychology trainees.

Nina Levine (program coordinator) and Philip Markovich (outreach and assessment coordinator) facilitated liaison between the community facing campaign and the clinical service.

Markovich largely became the face of Mindmap in the community. He promoted the program at pop-up events like the New Haven Road Race, Fresh Check Days at local colleges, and events for community stakeholders like clinicians, clergy, and politicians. He said his goal was to spread information about how Mindmap and STEP could be a resource for people and families who needed help with their mental health.

“We also worked to help break down stigma while engaging the community in meaningful dialogue about general mental health and psychosis,” he said. “I liaised with clinical inpatient and outpatient mental health professionals to educate them on our program and encouraged them to refer to STEP when a case seemed appropriate.”

Markovich also took calls from people who wanted to learn more about the program or get help for their loved ones. He introduced clients to clinical team members, interviewed patients, and collected data that became important markers in the analysis of the client’s baseline and progress in treatment.

“The STEP Program made a unique offer of quick, free, individualized treatment from a coordinated specialty care perspective with a very informed group of mental health professionals trained to help those with early onset of psychosis,” he said. “Many people who called were happily surprised -- albeit initially somewhat skeptical -- when told about all of this, as well as the wrap around services like vocational and educational support and family therapy. It is a great program and the data backs that up.”

Mindmap was launched after it was shown that STEP could provide quality, affordable care in the community.

From 2006-2013, STEP operated as a research clinic at CMHC with support from the NIH, DHMAS, and the Donaghue Foundation. The concept was to test empirically based, international standards of care in a public mental health setting in the United States. Starting in 2014 STEP implementing a population-based approach proactively targeting all new onset cases within a defined catchment, and with Mindmap it has further strengthened regional care pathways.

STEP is now working with leadership at DMHAS to expand access to best practice early intervention services across Connecticut. STEP is also involved in two multi-state US networks focused on clinical research and dissemination of early intervention for schizophrenia spectrum disorders.

Submitted by Christopher Gardner on February 02, 2022