“People who are served by CSC feel like they’re more than just another patient,” Greg Hansch says. “They feel more valued as a human being with strengths, assets and competencies.”

Illustration of man on the ledge of a cliff and a man holding a small trampoline below

First episode psychosis (FEP), or early psychosis, befalls 100,000 young people each year—some as young as 13, though more commonly symptoms manifest between the ages of 18 to 24. According to the National Alliance on Mental Illness (NAMI), psychosis refers to “disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t.”

If unaddressed, the already distressing experience of FEP—characterized by sensory hallucinations, emotional volatility, self-imposed isolation and other dissociative behaviors—will only intensify over time. To prevent or shorten delays in FEP treatment, mental health advocates are pushing for the expansion of Coordinated Specialty Care (CSC) programs, which offer a recovery-oriented, team-based and all around more robust alternative to conventional services and supports.

To date, funding for CSC sites and teams in Texas has been strictly federal. But with the Texas Health and Human Services Commission (HHSC) officially requesting state funding this legislative session, that might change. In this episode of Into the Fold, Colleen Horton, policy director for the Hogg Foundation for Mental Health, and Greg Hansch, public policy director for NAMI Texas, explain why CSC is so effective in treating early psychosis.

Making Individual Recovery a Team Effort 

At present, conventional psychosis treatments focus on medicating symptoms, rather than promoting a patient’s full recovery. If psychosocial support is involved, it usually takes the form of lessons on self-advocacy, leveraging natural capacities and the like—valuable information, but less effective when merely prescribed rather than decided on collaboratively. What’s more, 74 weeks—almost one and a half years—pass before the average person seeking services “receives any care whatsoever”, as Hansch puts it. 

“The whole purpose of expanding Coordinated Specialty Care sites is to get the services into the communities where they’re needed,” Horton says. CSC teams, true to their emphasis on “team-based” recovery, examine each case for opportunities to implement family and community supports.

The result is a safety net that is efficient, comprehensive and deeply tailored to the individual. And according to clinical research studies conducted by the National Institute of Mental Health (NIMH), it works—compared to conventional approaches, CSC recipients are less likely to relapse and more likely to achieve long-term academic or occupational success.

“They’re not just another number being processed through a mental health system,” Hansch says. “They also feel very supported [by CSC] in their goals.”

Expanding Coordinated Specialty Care in Texas

By zeroing in on FEP, CSC programs commit to reducing critical delays in treatment. For some, earlier intervention can mean the difference between staying in school and ending up homeless or in the criminal justice system. “The investment we make in making sure those services are available can really change the trajectory of people’s lives,” Horton says.

In Texas, the implementation of CSC began with two sites—a number that has since grown to 10. Staffed by 12 teams, CSC sites can be found at local mental health authorities in Dallas, Houston, Austin, San Antonio, El Paso and a few other metropolitan areas across the state. Last year, CSC teams assisted about 519 individuals; this year, that number is expected to grow, as a new round of federal funding will support the creation of 11 new programs by 2020.

The state receives approximately 3,000 new cases of psychosis every year. At present, only an estimated 10 percent of existing cases can be addressed. The HHSC’s request for state funding, if fulfilled, could give CSC teams and services a significant boost.

 

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