SMU professor: New psychosis patients need early intervention

Michael remembers this incident clearly. The same goes for his sister.

“I thought my family was trying to kill me… I thought it was Jesus,” Michael said. Her sister Liza added: “It made my mother very depressed because she didn’t know how to help her.”

Unfortunately this is rare. Every day in the United States, up to 900 people under the age of 25 experience a first-episode psychosis, which can lead to schizophrenia and long-term disability without effective intervention. the first. On average, a young person will wait 3.7 years after their symptoms start before they receive treatment.

Michael, a pseudonym used to protect his privacy, was one of the 47 young people my research team at SMU Dallas spent time from 2014 to 2017. As trained psychologists , we recruited this group to investigate why nearly half of teenagers like Michael. refusal to follow up with mental health care after first hospitalization. Research shows that there is a critical period for early treatment after the “first episode” of psychosis; Delays in getting help and denial of care jeopardize a person’s chance of full recovery. Why would someone refuse to help?

To answer this question, my team and I spent some time in the same hospital emergency room several days each week for two years. We contacted young people from different backgrounds when they arrived with early symptoms of psychosis. With permission, we met with them and their families in their homes and villages for about a year.

We found that without early intervention, children like Michael often started down a dangerous path from which it was more difficult to return. Indulging in drugs and alcohol to “feel good” and agreeing sometimes worsened their symptoms. Isolation to avoid upsetting or disappointing them increased their anxiety and deepened their abnormal feelings. When things got bad, they became dangerous to themselves or others.

Early intervention in specialized treatment can prevent self-harm, substance abuse, homelessness, failure in educational and vocational goals, and interpersonal violence, but this is not something that young people many or their families know or understand it. Everyone just wants to get back to normal.

Although Michael’s family included many health professionals, they waited three years after his symptoms began to seek help. They watched in silence as their senior student and star athlete dropped out of college, hid in his room, and slowly sank into oblivion. They reasoned that maybe he smokes too much weed, or spends too much time alone, or doesn’t eat enough – all of which are true. However, Michael was just trying to control his mental confusion.

He explained: “Imagine that you have behaved well one day, and then it is as if someone is controlling your mind, and it is as if your mind is behaving badly.

Michael’s family eventually had to call the police when he tried to harm his niece during a family meeting. This type of dangerous behavior often happens because people wait too long to get help – not even realizing they have a mental health problem.

Later Liza was disappointed, “We didn’t know it was like that. … No one in our family has ever…” He couldn’t even say the words “mental illness.”

Most of the young people in our study became a danger to themselves or others, but waiting until someone is so violent that you have to call the police is not good for anyone.

Mental health or behavioral issues are associated with 23% of all police shootings, but luckily, Michael was safely escorted by police to the emergency room and admitted involuntarily. He was then taken to a state mental hospital where a month’s worth of treatment cost the equivalent of a year of college he was attending.

His family was distraught, rejecting Michael’s new psychiatric diagnosis of “schizophrenia” and the medication he was given to treat the condition. Michael didn’t like the side effects either. So, Michael went home but stopped taking the medicine. He returned to his room, afraid of his future. He felt that he was not the organizer of his life – he could not respect himself and did not think that others respected him. Looking back at his Facebook posts over the past few years, he said, “It looks like I’m the real me, but I don’t know who that person is.” He felt tired.

After six months my team never heard from Michael again. He never saw a doctor, stopped treatment, and refused medication. About half of the young people who talk about treatment for early psychosis, like Michael, don’t see further mental health treatment as the way forward.

Helping young people like Michael must start by preventing delayed care and improving crisis prevention and management. Here are three steps families and communities should take.

First, if more people are able to recognize the warning signs and encourage families to ask for help, it will be better. Families and caring adults who work with young people (eg, coaches, youth teachers, librarians) need to know how to recognize and deal with the signs of serious mental health problems before a young person becomes dangerous. A free, one-day course, such as Mental Health First Aid, can help. For help, special treatment centers can be contacted.

Second, everyone needs to know that ADHD medication and cannabis can make you feel better, but in high doses, they can make things worse – especially for people those with early psychosis. Prescribers of ADHD medications must regularly screen teens for signs of mental illness to avoid exacerbating problems when they arise. High-potency cannabis can also be psychotogenic, something many people need to be aware of. Medicines can be helpful and harmful, and we all need to know how to use the normal ones that are really available for young people in a responsible way.

Third, we need to develop safer alternatives to long-term hospitalization. These will be good for society and the economy – and probably won’t damage a person’s youthful confidence. Peer drop-in or crisis support centers are home-based and staffed by trained mental health professionals who can help young people and their families identify what recovery looks like and a better understanding of how to get there. They are also cheaper than the hospital. Hospitals may be the last resort, not the first, in an emergency.

Young people struggling with psychosis need support and immediate attention that gives them the strength to have at least some control in their lives so that they can continue to respect themselves and maintain the respect of others. We must connect young people struggling with psychosis quickly and provide care that gives them at least some control over their lives and encourages them to continue to respect themselves and maintain the respect of others. In this way, brokenness can become turning points that put a teenager back on the path to becoming a beloved adult.

Neely Myers is a professor of anthropology at Southern Methodist University and an assistant professor of psychiatry at UT Southwestern. He is the author of a new book, Conclusion: Young People’s Mental Health Issues and How We Can All Help (University of California Press, 2024). A PDF of the book is available for free download.

We welcome your comments in the letter to the editor. See the guidelines and enter your letter here. If you have problems with the form, you can send an email to letters@dallasnews.com