Study Reveals More Effective Way to Treat Schizophrenia
Time to RAISE the Amount of Care
Maggie, a 20-year-old nursing student, bravely stepped up to the podium in the Rayburn House Office Building at a Congressional briefing organized by the National Institute of Mental Health and NAMI. Maggie shared her personal experience living with schizophrenia and persistent auditory hallucinations to the Congressional staffers, colleague organizations and media.
She was there in part to announce the release of one of the most highly anticipated studies on mental health in years. The study, published in the American Journal of Psychiatry, and led by Dr. John Kane, discussed NIMH’s RAISE Program. RAISE, which stands for Recovery After Initial Schizophrenia Episode, is a groundbreaking initiative looking at how best to support people with early psychosis.
By using a public-health-staged approach, the RAISE program asks the fundamental question: can we do better for people early in the course of living with psychosis in real world settings? To which the answer appears to be a clear, yes. To quote Maggie, who participated in a related trial, it made her “want to not just live…but also, want to live a fulfilling life.”
This study was designed to compare coordinated psychosocial supports to regular community-based treatment. The goal was to determine whether the added services made a difference for the individuals who received the coordinated care. The study observed 223 individuals provided coordinated psychosocial supports and 181 individuals in regular community care. It sites trained community mental health workers in these evidence-based treatments.
The study looked at both quality of life and involvement with work and school during the first two years after the study began. The findings were that people receiving coordinated psychosocial support had much better results than community-based care alone. During the briefing, Dr. John Kane discussed the RAISE program’s success in engaging participants and improving overall quality of life. Dr. Lisa Dixon, also connected with the study, explained that the RAISE Connection program had similarly positive results, with participant hospitalizations down more than 50% and participants in school or working up nearly 40%.
The study also found that the impact of these interventions was much stronger if the person had psychosis symptoms for less than 74 weeks. This shows how critical it is to make access to services easier and to improve awareness and attitudes towards people seeking help if they have symptoms of psychosis.
The New York Times covered this story, but the original title of the online version of the article (the title has since been changed), which appeared on Oct. 20, was misleading. It framed the study as meds versus therapy instead of as a study of early intervention with comprehensive services. Unfortunately, this led to other misleading coverage by other news outlets. The Times printed a correction on Oct. 23, 2015 that said (emphasis my own):
“Though it studied a program intended to reduce medication dosages, the researchers do not yet know for sure if dosages were lowered or by how much. Therefore, the study did not conclude “that schizophrenia patients who received smaller doses of antipsychotic medication and a bigger emphasis on one-on-one talk therapy and family support made greater strides in recovery.”
The study did conclude that the alternative treatment program as a whole led to better outcomes.
This correction is an accurate summary of the research but the initial coverage led some people in the wrong direction for a few days. I received emails asking, “Should I stop my meds based on The New York Times article?” The answer is no. That is a question for you and your doctor to sort out.
RAISE showed that the extra services made a real difference in the following two years after the first signs of psychosis. Maggie’s mother, Maureen, said the program gave her daughter the ability to move forward with her life and the knowledge and skills she needed to help her along the way.
As NAMI Executive Director, Mary Giliberti, said at the RAISE briefing, “This isn’t just about the numbers. This is about real lives.”
Now what we need to find out is if these added services improved outcomes over a longer time. For example, if it helped to keep people at a higher level of functioning in school or work over a decade. It would also be important to understand if the added services can help to save money over time, by reducing hospitalizations and disability.
NAMI has been very fortunate to have a great relationship with Dr. Robert Heinssen, Director of the Division of Services and Interventions Research at NIMH, and Tom Insel, the former director of NIMH who recently stepped down from his position to assume a position at Google. Both Tom and Robert have helped to lead this crucial public health approach to treating people with psychosis. We salute NIMH for conducting this research, and I look forward to following this line of research and sharing it with the NAMI community. We look forward to the continued great collaboration efforts as the field tries to understand what works and in what stage of illness.
I think the young woman summed up what the heart of this research showed us: “You can live your life with [schizophrenia]…it’s not hopeless.”
– See more at: http://www.nami.org/Blogs/NAMI-Blog/October-2015/Time-to-RAISE-the-Amount-of-Care?utm_source=naminow&utm_medium=email&utm_campaign=naminow#sthash.EixxkZRI.dpuf