Innovative treatment for schizophrenia by the Family Service Agency and researchers at UC San Francisco shows great promise in improving patients’ mental health and cutting costs.
The disease, which usually strikes in adolescence and can last a lifetime, affects an estimated 6,000 San Franciscans and 70,000 in the Bay Area.
About 170 local patients have gone through the Prevention and Recovery in Early Psychosis or PREP program, which emphasizes early intervention, counseling, cognitive training and use of fewer pharmaceuticals in lower doses to treat the mental illness. Specialized software from San Franciso-based Posit Science trains schizophrenic patients to distinguish hallucinations from rational thinking — which may help alter how their brains process information.
Samantha is among those local patients.
She had been an outgoing, popular student and athlete in high school. At age 19, during her freshman year in college, she began to hear voices. They started as a whisper then grew in volume and ultimately demanded much of her attention and energy. She withdrew from friends, and became fearful her phone was being tapped and the police were tracking her. Emails and phone calls to her parents became confused.
Alarmed at Samantha’s sudden transformation, they brought her home to San Francisco and found a therapist who knew of the joint FSA-UCSF program and referred her. She and her family got training, and Samantha was diagnosed with schizophrenia. She worked with clinicians to find the right balance of medication, therapy and “hope for rebuilding her life,” her clinicians recall. Therapy helped her reduce stress and deal with voices in her head. Her family communicated with others in the same situation. After two years, Samantha was able to return to college, reconnect with friends and start fresh, sporting a B average and a starting position on her college’s women’s volleyball team.
Treatment turns lives around
Samantha’s story could have turned out very differently if she hadn’t gone to a therapist familiar with the program at FSA and UCSF. Many young adults in similar situations become trapped in a down spiral that can lead to dropping out of school, not working, living in poverty, depression and other ills.
But thanks to the partnership’s efforts — and similar approaches in Great Britain, Australia, Scandinavia and Oregon — schizophrenia is going from being a largely untreated condition to one with a consensus on how to detect and treat it among experts worldwide, according toBob Bennett, FSA’s chief executive.
“People who get this treatment can live a different life for 50 years,” said Bennett, who compares it to the discovery in the early 1920s that insulin could be used to treat diabetes and control the disease’s impact.
Serious mental illnesses, including schizophrenia, cost nearly $318 billion a decade ago, according to data on the National Institute of Mental Health’s website, and schizophrenia accounted for an estimated $50 billion of that total.
Schizophrenia typically emerges in later teenage years or early twenties, often with catastrophic results and huge expense. Many doctors treat the condition with high levels of anti-psychotic medications, which can have severe side effects that make recovery more difficult, and result in multiple expensive hospitalizations, treatment refusal by patients and greater disability, say experts in the program.
Schizophrenia affects roughly 1 percent of the population, unrelated to income levels, said Dr. Rachel Loewy, the clinical psychologist who heads UCSF’s research team on the project. “People get hospitalized, get put on medications to calm them down and don’t get good outpatient treatment” in many situations.
“The earlier they’re treated after a psychotic episode, the better the outcome,” Loewy said. “Decades later, they do better in social and work functioning. It’s critical to get people help as soon as possible.”
As a result, the program puts a premium on community outreach, through schools, teachers, hospitals, clinics and community centers to help identify teenagers and young adults who may be showing early signs of schizophrenia.
Salesforce grant boosts app
FSA won a highly competitive $4.7 million Health Care Innovation Award from the federal Centers for Medicare and Medicaid Services last summer, nabbing one of about 100 grants sought by more than 3,000 contenders. The partners introduced the approach first in San Francisco, and later in Alameda and San Mateo counties, with plans to take it to San Joaquin County and later elsewhere in California.
It also nabbed a $200,000 grant from the Salesforce.com Foundation, along with discounted software.
Philanthropic support from Salesforce helped FSA develop a mobile case management app that could potentially help other nonprofits become more efficient. FSA’s for-profit company, called Circe, also headed by Bennett, will sell the app.
“They were getting enormous advances in productivity,” said Barbara Kibbe, chief operating officer at Salesforce.com Foundation. “We funded them to develop (a generic version of Circe) for use at other agencies.”
Since the FSA program is based in the community and treats people who are poor and can’t pay for services, much of its funding comes from government, including tax money through the state Mental Health Services Act, which has provided steady funding.
Initial results for fewer than 200 participants include a 50 percent reduction in hospitalizations, which are expensive and also — according to FSA and UCSF experts — tend to intensify the disease’s longterm impact. The PREP program has greatly improved participants’ ability to stay in school and on the job, and maintain or build relationships.
Schizophrenia often strikes when young people are starting college or jobs and looking for a romantic partner, so its impacts at a crucial developmental stage can be grim if not properly treated, Loewy said. So PREP works with families, emphasizes group therapy, “while keeping medication levels low so the (patient) is more likely to stay on them long term.”
Many of the medications have nasty side effects, such as sedation and risk of diabetes and significant weight gain, among others — not effects a young adult is likely to want, contributing to the number of people who go off their medication.
Although the public and media often connect schizophrenia with criminal behavior due to a small number of highly publicized cases, researchers say people with the disease are much more likely to be victims of crime than perpetrators — or to take their own lives in response to depression connected with the disease.
“Because their symptoms,” which may include inability to distinguish hallucinations from reality, Loewy said, “they’re easy targets for bullying, abuse and violence.” Unless, like Samantha, they find a way out of the maze and back to a more structured existence.
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