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'Game-Changer' Study Says There's A Better Way To Treat Schizophrenia

The Huffington Post The Huffington Post 20/10/2015 Jonathan Cohn
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A groundbreaking new study adds to a growing body of evidence that people with schizophrenia can do much better if they get the right treatment at the right time.

Psychiatrists are sure to pay attention to the results. Policymakers eager to do something about mental health may want to do the same.

The study, which the American Journal of Psychiatry published on Tuesday morning, is the latest attempt to test “early intervention” -- a treatment strategy that researchers around the world have been developing for approximately the last 25 years. (Early intervention was the subject of a lengthy Huffington Post Highline article that appeared last week.)

Historically, psychiatrists have treated schizophrenia, which affects about 1 percent of Americans, largely by administering high doses of antipsychotic medications. Some patients recover fully but the majority do not. Instead, those people end up living with severe disability, dropping out of school and living without regular jobs.

Medications can blunt some of the most visible symptoms, but the drugs have severe side effects, causing many people to stop taking them altogether. In some cases, people with schizophrenia end up on the streets or in jail.

Economists have estimated that schizophrenia costs the U.S. more than $60 billion a year, once you account for treatment, lost productivity and other expenses.

In the early intervention model, teams of mental health professionals administer medication in relatively small doses, while focusing more on therapy and support designed to help people stay in school or on the job. Timing is also important. A key focus of early intervention, as the name suggests, is to reach patients shortly after they first experience serious psychotic symptoms, like hearing voices or having delusions about conspiracies. That doesn’t typically happen today. It can take a year or more between the onset of psychosis and treatment.

In countries like Australia and the United Kingdom, early intervention is becoming the standard of care -- thanks in part to decisions by government officials to pay for services through their national health insurance systems. In the U.S, with its patchwork insurance system and history of underfunding mental health care, early intervention is generally available only through small pilot programs that operate out of academic research centers and reach a fraction of the potential population. (The exception is Oregon, where a sprawling program has existed for over a decade.)

The paper published Tuesday comes from experiments, organized and financed by the National Institutes of Mental Health, designed in part to test whether early intervention can work in this country on a much wider scale -- and outside of these elite, specialized centers. The results are encouraging. According to the study, which focuses on more than 400 patients in clinics from 21 states, those people who got the early intervention -- or “coordinated specialty care,” as it’s sometimes called -- fared better on a variety of indicators designed to test psychiatric health. 

In the study, the median length of time between onset of psychosis and treatment was 74 weeks. Those who got treatment before that point were substantially better off than those who got treatment afterward.

“The United States is really a decade behind the rest of the world in doing what we already know works,” said Vinod Srihari, an associate professor of psychiatry at the Yale School of Medicine, told  The Washington Post . With the new findings, “it’s possible now to say that in many community settings ... it is possible to deliver this kind of coordinated care and the outcomes are good.”

Kenneth Duckworth, medical director for the National Alliance on Mental Illness, told  The New York Times that the findings were a “game-changer for the field.”

The lead author on the study is John Kane, a psychiatrist based at Zucker Hillside Hospital in New York whose research helped lay the intellectual foundation for early intervention. One of the co-authors is Robert Heinssen, director of the Division of Services and Intervention Research at NIMH -- a key architect of the studies that produced Tuesday's paper.

Tuesday’s publication comes just a few months after the release of another pivotal study , by Yale’s Srihari, on early intervention. That study, based on an experimental program in Connecticut, found that early intervention reduces costly hospitalizations and, as a result, can actually save money.

Early intervention is not a cure for schizophrenia and, as even its promoters warn, there’s not much evidence on the long-term effects. (A key factor for long-term improvement may be the quality of care that people get after leaving the programs, which usually last just two or three years.) But those researchers also say that the short-term results alone represent substantial improvement over the status quo -- enough to warrant making early intervention more widely available, as it is in other countries.

And that might get the attention of policymakers who, in the wake of recent mass shootings, have said they want to invest more heavily in mental health services. In 2014, Congress set aside $25 million for states that wish to start their own early intervention programs -- in an effort to provide some of the funding that insurance does not offer on its own. A new allotment, doubling or tripling that amount, would make early intervention accessible to many more people, with minimal impact on the federal budget.

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