Rutgers opens first-episode psychosis outpatient clinic for young adults

Mar 10 2017

Psychotic illness affects approximately 100,000 young people nationwide, according to the National Institute of Mental Health. But until recently, New Jersey had no clinics to help teens or young adults within their first two years of exhibiting symptoms when intervention is likely to be most effective.

Rutgers University Behavioral Health Care (UBHC) recently opened a first-episode psychosis outpatient clinic in its Edison Metroplex location to serve 15-to-35-year-old residents of Middlesex, Monmouth and Mercer counties, funded by a grant from the New Jersey Division of Mental Health and Addiction Services. Two other grant-funded clinics - in Paramus, managed by Care Plus, and in Cherry Hill, managed by Oaks Integrated - also recently began serving young adult patients in those regions.

Early adulthood provides the best window for intervention, as this population is at a crucial point in developing independent living skills, career goals and relationships. "The longer someone has a serious mental illness that affects their development, the more difficult it is for them to get back to their desired level of functioning in educational, work and social settings," says Steven Silverstein, Rutgers' clinic director.

New Jersey is among a growing group of states addressing care for young adults who have experienced early psychosis, following a 2016 Congressional mandate requiring that states set aside 10 percent of their mental health block grant for use in treating first-episode psychosis.

Psychosis - characterized by an impaired sense of reality - typically occurs between the ages of 18 and 28. First-episode symptoms appear gradually, often pushing people into state of denial: They know something is amiss but assume it is temporary, says Silverstein. Troublesome signs include seeing or hearing things that no one else does, withdrawing from family and friends, having difficulty concentrating and experiencing a decline in self-care.

"They may not admit they have a diagnosis of a psychotic disorder, but they will admit that they are having experiences - like lack of concentration, poor grades or hearing voices - that are interfering with meeting their life goals," Silverstein says. Focusing on how recent changes are interfering with life goals, rather than on whether the person does or does not have a disorder such as schizophrenia, is an important part of motiving a young person to enter treatment.

A clinic, such as UBHC's, dedicated to young adults and staffed by professionals with specialized knowledge in treating this population, is key to long-term success. "There are big changes that happen in the brain from about two years before the onset of psychotic symptoms to three years after," he explains. "This is why early identification of people in need of treatment, and provision of treatment as early as possible, are critical. Unfortunately, the average person with a first episode of psychosis currently can go 15 months or longer with symptoms before treatment is provided, leading to greater challenges in helping a person recover."

Silverstein notes that most treatments for psychotic disorders are designed for those who have been living with these conditions for many years, which can be a deterrent to teens or 20-somethings in need of care. "Young people cannot identify with older adults who have been living on medication for decades and will often leave clinics," he says. "In addition, these treatments do not address the specific concerns of people of this age group, such as finishing college, landing that first job and dating."

UBHC's program, which can treat up to 50 people at a time, accepts patients who are within two years of the onset of psychotic symptoms, such as auditory hallucinations, severe paranoia or delusional ideas. Prior hospitalization is not required to qualify for treatment.

The clinic plans to treat patients for about a year before transitioning them to a traditional outpatient program. While under the clinic's care, people in treatment meet weekly, or as needed depending on treatment goals, with different members of the treatment team, including a therapist, psychiatrist, family therapist, peer support and wellness specialist and a substance abuse counselor. Patients also can use the services of an employment and education specialist, who can provide them with support as they transition back into a job or to school.

The clinic also educates families on how to work with the treatment team and support their loved ones.

"The goal is to reduce a person's symptoms so they can return to their lives, needing less treatment," Silverstein says. "Ideally, after an initial period of more frequent assistance, they can scale back to coming to this clinic or another program once a week or less."