EXAMPLES OF POSSIBLE ACTIONS

1.1 Include stakeholders who experience psychosis on committees that make decisions about early psychosis resources, services and research (ex. DMH IRB, DMH, research advisory boards)

1.2 Increase resources for peer specialist roles on early psychosis teams; provide avenues for peer specialists to collaborate across programs and to advocate for needs in these roles.

1.3 Expand the reach of early psychosis support groups for individuals and families; for example, developing peer- and clinician-led support groups available regardless of program enrollment (see Wellspace groups at McLean, McFarlane multi-family groups, Australia’s Headspace model), or utilizing virtual spaces for community-building and outreach (ex. apps & social media)

1.4 Provide specialized services to support individuals in achieving goals related to education and employment

1.5 Develop and strengthen supports for families & caregivers of individuals experiencing psychosis (Examples: In-Reach approach to teach motivational interviewing for caregivers)

1.6 Provide assistance with housing and food insecurity for individuals experiencing psychosis

CHALLENGING STIGMA

Expand informational resources and programs for individuals and families who experience psychosis; Promote avenues for peer-led interpersonal support for individuals and families (ex. Hearing Voices groups); Implement evidence-based treatment approaches to address internalized stigma within the context of early-course psychosis treatment programs

EXAMPLES OF POSSIBLE ACTIONS

2.1 Identify communities that are underserved by existing treatment programs and develop specialized approaches to outreach and support in these communities (ex. through churches or tribal governments)

2.2 Implement a public awareness campaign regarding signs and symptoms of psychosis, screening tools, etc. (see Yale MindMap campaign, https://mindmapct.org/about/)

2.3 Increase visibility of available resources and improve online information; for example, funding a marketing & media coordinator for early psychosis services or reassessing resources on the DMH website

CHALLENGING STIGMA

Implement evidence-based anti-stigma programs to reduce community-level stigma associated with psychotic symptoms and increase hope for recovery.

EXAMPLES OF POSSIBLE ACTIONS

3.1 Develop a statewide centralized triage and navigation service to provide quick access to consultation & support in early psychosis and facilitate rapid connection of individuals and their families with care (ie. “MCPAP for psychosis” model)

3.2 Train community leaders & programs in the early signs, symptoms, and referral options for early psychosis (ex. schools, religious communities, youth programs, law enforcement/forensic programs, EMTs)

3.3 Create collaborative relationships between community organizations (emergency service providers, schools, etc.) and early psychosis assessment and treatment resources

3.4 Support local law enforcement in developing organizational procedures and culture that promote safe and compassionate interactions with people in crisis, including the provision of Mental Health First Aid and Crisis Intervention trainings (see IACP One Mind Campaign & Police-Mental Health Collaboration Toolkit).

CHALLENGING STIGMA

Integrate anti-stigma and recovery-oriented content into trainings for community programs

EXAMPLES OF POSSIBLE ACTIONS

4.1 Improve psychosis-specific resources in psychiatric inpatient units & strengthen connections to community programs; for example, developing a FEP-specific inpatient unit, supporting structure and psychosis competency in existing units, promoting continuity of care and discharge planning for transitions between inpatient and outpatient settings, and developing peer support/peer navigator programs within hospitals

4.2 Assist family members and practitioners in acute care settings in connecting to early psychosis treatment services (See description of centralized triage and navigation service in goal 3.1)

4.3 Create collaborative/integrated relationships between medical/behavioral health providers and specialized early psychosis teams

4.4 Educate behavioral health providers to, at a minimum, screen, detect, and refer to specialized services for psychotic symptoms (inpatient, ESP, and outpatient services)

4.5 Increase psychosis competency among community and private practice mental health providers for those who are being discharged from an early psychosis program or who may not need the level of support offered by specialty programs

CHALLENGING STIGMA

Implement anti-stigma training for medical and behavioral healthcare professionals

EXAMPLES OF POSSIBLE ACTIONS

5.1 Promote the development of new early psychosis coordinated specialty care (CSC) treatment programs in underserved areas across the state and support high-quality, whole-person, and recovery-oriented care initiatives across new and existing programs. Using a stepped-care framework, these programs should have capacity to adjust the intensity of the intervention based on the fluctuating needs of individuals and families over time

5.2 Maintain capacity to provide intensive outpatient service for those needing a higher level of care (ex. PREP)

5.3 Maintain the infrastructure necessary to provide expert training and consultation in the implementation of evidence-based practices to providers in early psychosis programs (ex. MAPNET)

5.4 Address issues of accessibility for telehealth and in-person services among clients & families; for example, using telehealth and mobile teams to increase access in communities far from urban academic medical centers, providing laptops/broadband for clients & families to address accessibility needs related to telehealth, and supporting access to in-person treatment through transportation programs and geographic flexibility

5.5 Support community programs within treatment settings such as cooking classes, exercise/sports groups, special interest groups, etc. that help clients to live healthy and active lives

5.6 Adapt engagement and treatment models to best meet the needs of culturally and linguistically diverse communities; for example, building a diverse workforce and increasing access to interpreter services

5.7 Invest in building a racially, linguistically and culturally diverse early psychosis workforce by providing paid mentorship and training opportunties for students, clinical trainees and residents from under-represented minority groups to learn to specialize in treating early psychosis

5.8 Support CSC programs in addressing comorbid substance use in treatment

CHALLENGING STIGMA

Survey knowledge & beliefs about recovery among early psychosis treatment providers; Standardize the inclusion of recovery orientation in the training process for early psychosis treatment providers

EXAMPLES OF POSSIBLE ACTIONS

6.1 Assess and address issues related to capacity in the early psychosis care system; for example, addressing clinician burnout and turnover, utilizing community-level interventions (ex. Horyzons platform in Australia), and assuring that graduate programs and training sites are training future behavioral workforce members in recognizing the signs of early & emerging psychosis

6.2 Expand and diversify the workforce of trained staff across early psychosis services; for example, providing intensive training in psychosis for graduate & undergraduate students, developing incentives to reduce staff turnover, and increasing racial diversity in the mental health workforce (see 5.7)

6.3 Implement evidence-based strategies to monitor and address the mental health impact of marijuana legislation; for example, promoting evidence-based legal regulations for THC content and labelling of cannabis products, developing a community education campaign, or considering a “sin tax” wherein tax dollars generated by marijuana sales are allocated to support early psychosis services

6.4 Enhance sustainability in billing practices by creating a standardized program-level day-rate for early psychosis treatment reimbursable by third-party insurance payers. Formalize billing structures for services that are not currently 3rd party billable, e.g. peer support, psychoeducation, employment/education support, team meetings, coordination of care between acute & outpatient services, community education and outreach. Ensure that treatment is available in some form to everyone regardless of insurance coverage.

6.5 Evaluate implementation strategies that support the translation of innovative evidence-based practices in non-research settings

6.6 Utilize data to monitor needs in early psychosis services, capacity of the behavioral health system to address service needs, quality of services provided, and to evaluate impact of services received (via standardized systems for outcome evaluations & regular assessments of fidelity across teams implementing CSC or other EBPs)

CHALLENGING STIGMA

Identify employer practices and policies that exemplify best practices in inclusion and stigma reduction for psychosis, and promote the use of these practices in new and existing systems/policies