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Treatment of psychosis – and other mental illnesses – dramatically differs from the county | The Castle of the Lost Coast

Last December, Bridget Fitzgibbon's son, Evan, entered a catatonic state. The acute psychosis had suddenly struck a few weeks earlier, by the end of the autumn semester of his second year at Bard College in New York. Caught in horrifying delusions, his body began to close.

FitzGibbon and her husband, Taylor, forced her 20-year-old son to a hospital in Sonoma County where they live. An acquaintance told them about a promising program for young people experiencing early psychosis. But the family quickly found a problem: the program did not exist in their county.

In California, geography creates significant barriers for people who receive early psychosis as well as for a number of other evidence-based treatments. This is partly because the 58 County of California have 58 different public mental health programs, each with its own suite of covered services.

"If you board a bus in northern California and take it to Southern California, you get different services depending on where you get out of here," said Carmella Coyle, president and CEO of the California Hospice Association, a lobbying group for state hospitals. "It's just unfair."

Dr. Tom Insell, who recently appointed Governor Gavin Newsom as his supreme mental health counselor, likens the 58-finger fragmentary system of piano playing.

"There is no central leadership," said Inchel, a former director of the National Institute of Mental Health. "If you ask: are What are the regions trying to achieve? What are their goals? What is their northern star? "I can not tell you that. There is a North Star in the LA County, in San Mateo, in Alameda. They are not the same. "Insel and many other mental health experts say that California offers too little guidance and supervision to ensure fair access to mental health care, missing opportunities to spread best practices across countries across the country.

wishes the state to set specific targets for mental health outcomes such as reducing suicide and imprisonment of people with mental illness. He also wants the state to help countries achieve these goals. Among his most important priorities is the early intervention of psychosis.

"For most children who can receive such treatment shortly after the onset, they will do very well," Inchel said. "They can continue to really have a life that is not happening today with a diagnosis of schizophrenia."


About 100,000 adolescents and young adults have national psychosis every year, according to federal figures – and three out of 100 will experience psychosis at some point in their lives.

In recent years, mental health policy makers and providers have begun to be enthused by early psychosis intervention programs, which usually involve intensive counseling, psychiatric treatment, and peers and family. support, with trained vendors working closely together to coordinate the care of each patient. In 1966, the federal government devoted 10% of Community mental health subsidies to early psychosis programming; in California, amounting to 9.5 million dollars. Legislators this year proposed to allocate 20 million dollars for early psychosis programming in California's new budget, which is 5 million dollars less than the governor's demand.

Right, research shows, programs can dramatically help young people suffering from psychotic symptoms with lasting benefits. The opposite is also true: the longer the psychosis remains untreated, the worse the result. People with an initial diagnosis of psychosis are approximately eight times more likely to die in the year after their diagnosis as people in the general population. The reason is often suicide

According to a national survey, clients in early psychosis programs continue to be treated longer, less likely to experience symptoms, participate more often in work or school than do other caregivers – provided that they are rapidly on treatment, a Canadian study published last year in the American Journal of Psychiatry shows that people who participated in early psychosis after their first episode were four times less likely to die.

for 74 weeks. Other countries have drastically reduced this number

18-year-old Christine Marie Frey has been attending an early psychosis program in San Diego after she began to listen to demons as a 12-year-old. She is the author of "Brain XP: A Mental Illness, a Perspective of a Young Teenager"

18-year-old Christine Marie Frey attends an early psychosis program in San Diego after she began to hear demons like a 12- year. She is the author of "Brain XP: A Life With Mental Illness, a Perspective of a Young Teenager"

Christine Marie Frei, now 18, attends a program in San Diego after she began to listen to demons like 12-year old. He offered personal and occupational therapy, as well as help with attention, medication, and school. Frey found comfort to talk to peers in similar circumstances.

"They helped me realize not just how to do it – they helped me to feel like myself again," she said. "I went in there, ready to give up." Early interventions of psychosis can be targeted at young people with symptoms that place them at high risk of psychosis or those who have had their first experience with psychosis. Those in the first group could hear a whisper and wonder if their brains play with them; the second group is more likely to believe the voices are real.

In California, only about two dozen districts have early psychosis programs. Most do not have the money or capacity to provide them to all residents of the county. Often, the only eligible people are those without insurance or Medi-Cal for low-income californians, although in some cases private insurers pay for patients.

He grew up, Evan has always been a strong student and talented musician and athlete, his mother said. But as he approached the end of his autumn semester, he was increasingly worried about choosing a major and meeting musical terms.

For several nights he stopped sleeping. On the 20th birthday, a friend made him go to the emergency room. He gets medications to help him fall asleep, but he's still getting worse. His father ran across the country to take him back to Sevastopol, assuming that the comfort of home would help.

After his parents heard about the early psychosis program, they said they had asked their insurance provider, Kaiser PERMANDENTE, for a referral, but Kaiser refused.

In a statement sent by email, Dr. Samir Assure, assistant executive director of the Kaiser Medical Group in Northern California, said Kaiser is not just an "insurer" who pays for outside services.

"Kaiser Permanente is an integrated healthcare system that provides expert, evidence-based medical assistance to our members, including in the field of psychosis," says Awsare. He added that Kaiser follows the federal "best practices" for cognitive behavioral treatment of psychosis and multi-group group treatment, and when clinically appropriate, Kaiser directs for external programs.

Bridget Fitzgibbon with his son Evan. After he began to have illusions in December last year, his parents discovered that the early intervention of psychosis was not available in their native Sonoma region. This photo – and the photo – by Penny Gladstone for CALmatters.

He cites the patient's confidentiality in refusing to discuss Evan's case. But Evan's parents did not feel what they said Kaiser suggested – a common intensive outpatient program in which most patients did not have psychosis, meeting with a psychiatrist every few weeks, and therapy every week or so – is enough.

So Evan's father did it every week or earlier at the UC Davis Early Clinic for Diagnosis and Preventive Treatment, a modern program in Sacramento. The trip was about four hours and the family paid thousands of dollars for his care, with the help of a GoFundMe account created by the primary school teacher.

Evan stabilized and began to improve, said his mother. But the long carts carried his son and his father who had severe pain in the back. Pocket costs were too high. Coming from so far, Evan was hard to take part in peer groups. Although Bridget Fizzibbon said they would like to continue, they made the difficult decision to stop several months in the program in May. "I do not know," said Fitzbibbon, whose son gave permission to share it. history. "It's just disappointing to see how the system is broken. I think we did the best we could.

Bill Carter, who recently became director of the mental health of Sonoma County, said he was determined to introduce a program of early psychosis there, calling him "one of the best things to do."

is something we are waiting for in the field of mental health, "he said. "Historically, schizophrenia and other thought disorders have the potential to really devastate somebody's life."

Carter previously worked for the California Institute of Mental Health, making efforts to disseminate evidence-based practices, including early treatment of psychosis. He has also been the director of mental health in Napa County, who has provided early early 2014 the opportunity for early treatment of psychosis for every county resident who needs it regardless of insurance.

Napa manages this in part because of funding from One Mind, a nonprofit organization based on the local Staglin family, whose son, Brandon, recovers from schizophrenia in the 1990s and is now president. The Napa program also receives support from local wineries, a large charity auction, and various sources of federal and state funding.

But despite Carter's commitment to bring early psychosis programming to Sonoma County, he has encountered significant obstacles. Following the forest fires in 2017, the county faces huge budget deficits – and makes a sharp reduction in mental health.

It's a challenge to persuade the public to invest significantly in a prevention program for relatively few people, Carter said, especially when so many people are very sick people are running out of care. He would prefer the state to provide centralized leadership and support to help councils finance and develop early psychosis programs.

Why is not that the case? Why 58 Areas Are Making Things 58? Designed. In 1991, the state was confronted with a budget crisis, and in a process known as "reorganization," it transferred responsibility for providing mental health to the districts.

He also gave cities special financing of sales taxes and vehicle license fees, creating formulas based on how much each county spent at that time. Over the years, these funds have failed to meet either the needs or the adaptation to population change.

"It is not necessarily the rhyme or the reason why an area chooses to provide some services, not others. The best way to describe it is a broken delivery system. "

In 2004, voters in California adopted the initiative on the Mental Health Act, charging a tax to the millionaires of the state. It has pumped about $ 15 billion more for mental health, for which these countries turn to support flexibility.

The areas say they have to be nimble. In a state as vast and diverse as California, the problems faced by the rural Trinity are different from those of the city of Los Angeles. But the approach has shortcomings. "It is not necessarily the rhyme or the reason why a county chooses to provide some services, not others," says Sherry Low, vice president of behavioral health for the California Hospice Association. "The best way to describe it is that there is a broken delivery system."

What state needs, Law says, are basic services available in every community. Now, she says, the state does not monitor what services are provided in each county.

In 2012, the state closed its mental health department and moved many of its staff members to the Ministry of Health. Some believe that this move further detracts from mental health. "I think the counties are really rejected," said Randall Hagar, director of government relations at the California Psychiatric Association, representing the interests of state psychiatrists. "I would agree with the assessment that there is still no government leadership."

This is not true anywhere. Oregon has a comprehensive early psychosis program. The New York State has established OnTrackNY, a state-led effort to provide a coordinated care for the early psychoses of young people. Dr. Insell said he would like California to put such an effort. ] Bilder von 19459035 19459035 19459035 19459035 19459035 19459035 19459035 19459035 19459035 19459035 Dr. Cameron Carter, an eminent psychiatrist with great interest in early psychosis, hired her at the Sacramento clinic he founded.

Today the staff includes psychiatrists, therapists, family lawyer, and education specialist. and employment, as well as a worker dedicated to meeting the social needs of patients, such as housing. Patients participate in peer and family support groups.

Tara Nendam, who has left, meets the staff of the UC Davis Behavioral Health Center in Sacramento. It helps to guide efforts to expand the intervention programs of early psychosis across the country. Photo by Max Whitaker for CALmatters.

Too often, says Nianndam, people "just swim around in our system, sometimes taking inadequate care." Effective mental health care does not just make the symptoms disappear, she said. It gives individuals and families the tools to pursue a meaningful life.

"This is more than one pill that can be done," she said. used – began to visit the Niendam clinic after suicidal thoughts and hallucinations. Meheretab, who has Medi-Cal, said the rare treatment he gets through Kaiser is not working. Niendam's clinic felt safe. With a combination of medication, counseling, workplace support, and a peer group, he said, his depression has subsided and hallucinations are over.

"I feel I'm in a better place right now," he said. Niendam helped the towns of Napa and Solano to begin early psychosis programs and is currently doing the same with Yolo County. Small countries can struggle to hire and train the staff needed for a full program of early psychosis, so it develops a way of concluding contracts with larger counties or using telemedicine. She wants to expand the treatment model across the country.

Watching people who have been hospitalized 10 times return to school or work full time and show them that they can recover, "are the things that keep me every day," "This is a change to the game for all. It is super exciting to be part of this. "


Jocelyn Wiener is the author of CALmatters. This story, the fourth in our series "Breakdown: Mental Health in California," was supported by a grant from the California Health Care Foundation. CALmatters.org is a nonprofit media company that explains California's politics and politics.

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