How The United States Treats Psychosis Is All Wrong
Do you know how the United States treats psychosis -- a condition that affects millions of Americans? I am not an expert in psychosis, nor have I, personally, experienced psychosis, but one thing I’m pretty sure about is how the United States treats psychosis is all wrong.
What is Psychosis?
Psychosis is, quite simply, the presence of delusions and/or hallucinations. Delusions are strongly-held beliefs that aren’t true and hallucinations are experiences that don’t really exist. People who are psychotic are not “psycho” in any way – they are simply experiencing an overactive dopamine system in the brain (along with other neurological processes).
Who Are People with Psychosis?
People sometimes think that psychosis is very rare, but, indeed, psychosis affects about 2.5 million Americans with schizophrenia and many more with bipolar disorder type 1 (where psychosis is common during mania). (This article focuses on people with schizophrenia because that’s where the bulk of the data is.)
How Is Psychosis Treated in the United States?
Typical treatment for psychosis is to whack the person upside the consciousness with antipsychotic (generally atypical) medication. This medication does tend to be very effective at treating psychosis but comes with a whole host of side effects, not the least of which being cardiometobolic effects that can, indeed, shorten a person’s life. (And we know that even short exposure to antipsychotics can cause negative cardiometabolic effects on a person.)
What’s Wrong with Treating Psychosis Like That?
In the initial stage of acute psychosis, that may, indeed, be the best way to handle it. However, maintaining higher-than-necessary doses of antipsychotics and not supplying any other treatment is not doing anyone with psychosis any favors. This “treatment as usual” in the United States is the wrong way to treat psychosis in the long-term.
How Do I Know the US Treats Psychosis the Wrong Way?
In case you forgot, I’m not a doctor, but I am a person who was privileged enough to attend a talk by Dr. Robert K. Heinssen who studies first-onset psychosis for a living and he laid out the facts as we know them through the many studies that have been done.
And what we know is that while medication may be necessary in treating psychosis, only using medication as the usual paradigm is not nearly as successful as combining it with:
- Targeted early-intervention services, which decreases relapse and decreases both negative and positive symptoms of schizophrenia when compared with standard treatment
- Cognitive behavioral therapy, which decreases both positive and negative symptoms when compared with standard treatment.
- Family intervention, which decreases relapse or hospital readmissions when compared with standard treatment.
The three above points are the results of meta data from 11 different studies (see reference below).
And, in case you were wondering, most first-world countries, including Australia, Canada and most of Europe, have national programs for first episode psychosis – the United States, does not.
The most staggering statistic to come out of this talk is that the United States average for the duration of untreated psychosis in community settings was 72 weeks while, internationally, the number is recommended to be less than 12.
How Should the US Treat Psychosis?
According to a research project by the National Institute of Mental Health (NIMH) called Recovery After an Initial Schizophrenia Episode (RAISE) what is currently under investigation is:
- Assertive outreach and engagement
- Phase-specific, team-based treatment
- Empirically-supported interventions
- Low-dose antipsychotic medication
- Family education and support
- Cognitive and behavioral psychotherapy
- IPS model of supported employment and education
- Shared decision-making framework
Does all this sound expensive? To pencil-pushers and people without long-term vision I assume it must, but all of this has been shown to improve quality of life for people with schizophrenia (the monetary benefit of which is incalculable to individuals suffering) and is designed to reduce the costs to the economy (currently more than $62 billion a year) as well as direct healthcare costs (currently more than $22 billion a year).
What Can You Do If You Need Psychosis Treatment?
First off, early intervention in psychosis is critical and the earlier psychosis is treated, the better the prognosis. That’s the first and ultimate thing to remember.
But, also, some of the above programs are available in some areas from different organizations (try charities for people with schizophrenia) – so seek them out. Don‘t wait for your doctor to point you or your loved one in the right direction. And, if possible, get yourself in a trial program – many do exist. There are also private practitioners that may be able to help.
I know those are tough suggestions to swallow but until the United States develops a national strategy to better treat psychosis families and people suffering from psychosis are kind of on their own.
For the references used in this article, please see this PowerPoint presentation.
Tracy, N. (2015, May 3). How The United States Treats Psychosis Is All Wrong, HealthyPlace. Retrieved on 2021, May 11 from https://www.healthyplace.com/blogs/breakingbipolar/2015/05/how-the-united-states-treats-psychosis-is-all-wrong
Author: Natasha Tracy
Holy crap. My 22 year son has been in a psychotic break since 4/9/15 (his birthday) and hospitalized 3 times already. He is in a small area and has not really exercised, except when he was at home.
He jumps from sweet to angry to feeling worthless to on top of the world. He is on heavy doses of anti-psychotics with mood stabilizers.
I think he is probably bi-polar, but we are on a road of hand offs between in patient and outpatient, neither of which he can handle.
Hate the system, hate the treatment...
Sorry for the long post, but I've been thinking. I often read about people in the US struggling to get help for their bipolar disorder and/or psychosis. To give you an example, I searched the forum for 'insurance' and came up with many examples from just the last year of people not getting the support they need.
" *TW* Can't work full time, but have no other options?:
... There are community MH health clinics in my county where you can see a pdoc without insurance. it's not pretty and sometimes the waits are as long as 6-8 hours, for a 5 minute visit with a psychiatrist that barely looks at you, let .."
"Re: Intro: Rapid Cycling Bipolar w/ Psychotic Features:
... afford one of the prescriptions and the other two by themselves made me exhausted. I haven't been to a doctor regularly since then. I don't have insurance and don't qualify for state aid insurance until Fall. I'm doing a lot of self-help until then, such as being aware of my words and actions. ..."
"... such a terrible low again because I felt so helpless and in such pain. I am going to start seeing the therapist again. I am just waiting for the insurance to ok it. "
"Last week due to insurance issues my doctor switched me back to the regular version of Seroquel which we tried in the beginning of my treatment and didn't work."
"... I'm seeing my doctor on friday about increasing to 450 mg. How will I be taking that? As three 150 mg tablets every morning? I'm nervous that my insurance isn't going to pay for 90 of the 150 mg xl tablets...seeing as they're paying for only 30 of the 300 mg tablets right now."
"I have to sort out this mess with my husband first. We haven't divorced yet because I am on his insurance and need it desperately. "
"Hypo/manic today! :D Interview at 3 (oh no!)
... a doctor so that I'm not going into the interview at 3 sounding like a coke addict? I would really like to get this job as I kinda need health insurance to buy said meds."
" I was in therapy and on Prozac, Lamictal, and another medication for anxiety up until early 2013 when my insurance stopped and haven't returned to any form of outside help besides friends and family"
"I don't really know what to do. I can't afford health insurance or a psychiatrist anymore."
"That is one of my main problems I do not have psychiatrist anymore because my insurance is up. I go to psychotherapy because I have BPD as well and she is the cheapest route although she can not prescribe me medication she often ..."
i have PTSD w otherwise not specified psychosis. I went thru a three year early intervention program and got well. Unfortunately in Canada, mental health supports in the community are underfunded w long waiting lists. Yes early intervention is valuable but relapses happen bc of lack of long term supports. Only the very sickest get a case team. We are moving in the right direction but more needs to be implemented to those who are moderate.
Yolanda I feel you. I am Female, bipolar with occasional auditory psychotic episodes induced by the more extreme manic episodes. Those are rare, but the residual background murmur-y stuff (stress related) and permanent paranoia are only manageable, as you must well know, as well as I myself can 24/7. You can't cure those. Or knock them out with meds (fuck antipsychotics tho, they are lifesaving miracles in the middle of a serious scary serious episode, but otherwise they are foul body wreckers).
Anyway, yeah. Life is weird and isolated, SMIs, the differences between disorders, even the basics of medication classes are totally misunderstood. I had to explain to our office's Medical and Mental Health Liaison that an anti-depressant and an anti-psychotic/mood-stabilizer were not 'drugs' that her client (or anyone) could get 'high' from. She wasn't familiar with the individual brands/specifics, but also not even with the general types of meds! Also lithium is very dangerous to stop/start or mess around with doses. She didn't know, oops, that cutting off his long term prescribed lithium against his doctors wishes could have put him in a coma, given him a goiter, seizures, killed him, whoopsie. He was ok tho.
I'll stop b/c I'm starting to get mad, which is no good, heheh.
I am a high functioning bipolor person but after a few months I get episodes where I don't feel like pretending any more that I don't have this horrific disorder I'm a 54 year old women that has screwed up my entire life right now I have been high end shopping bad move
any suggestions each day I try to suck it up no move forward but I'm at a breaking point not suicidal but taking 2 too many Xanax today
Psychosis is a complicated issue, often wrapped in multiple disorders. When one has one disorder or issue, generally other problems have manifest either in response or organically. These tend to foster or exacerbate the issue.
If you add in any paranoia, or OCD or suicidal ideation, it is a tornado you're trying to saddle. Add in homelessness, or even simple stages of growth or change in the body (being a teenager or going through illness).
Being in the mental health community with SMI and loving someone with psychosis, it's a tenuous walk with many different presentations and it is mutable and changeable. Flexibility is very important, not only for looking at each individual, but at each individual at different times in their life. What works or is a trigger may not be the same next year. Fluidity, validity, safety, comfort but with stability (such as routines) allow for trust to be built which gives a higher likelihood of compliance and the ability to find a person's baseline. Having to start over and over again and never knowing what is baseline for a person makes it very difficult to know when a med is or isn't working, has a side effect or is a symptom, and for the person to have any quality of fulfillment in their life.
I love my community, we are the people that sometimes get eyes averted from, questions ignored, fears unaddressed and yet somehow, we still get up and comfort each other. SMI isn't a sentence. Thanks for this post
I am always shocked when I read the stories of US citizens online about their health care. In Australia I am automatically entitled to free, quality healthcare for my mental health. I do not need to have insurance, but if I do take out insurance I have the choice of private hospital and choice of doctor. I feel that this is crucial because people who are chronically unwell are usually chronically poorer because of their illness. Particularly in the case of mental health. Without a lot of support you could end up homeless!
On my first admission to hospital for psychosis, I was not yet diagnosed with my bipolar type 1, so I was given a diagnosis of psychosis-not otherwise specified. This was enough for me to be referred to the early psychosis program. I was assigned a psychiatrist and a case manager. The case manager is either an occupational therapist, psychologist, psychiatric nurse, or social worker.
The case manager met me just before I was discharged from hospital and established a rapport with me. She visited me at home and drove me to appointments. She sorted out practical matters such as accomodation or where to buy a cheap washing machine. She made a plan with me. She taught me how to recognise the early signs of intervention.
The case manager attended my psychiatrist appointments and followed up with medications. She taught cognitive behaviour therapy, and mindfulness strategies. She later organised cognitive rehabilitation for memory etc.
The case manager visited as often as needed. At first it was several times weekly, later fortnightly or at monthly appointments. With all of this support and specialised and individualised attention, I was able to get back to professional work, after 18 months.
The only mistake they made was taking me off the medication after all that. Because it wasn't just a single psychotic episode, it was bipolar. So one more hospitalisation then a diagnosis.
It's great to have such good care, and it is a preventative measure. Because I am doing so well under this care, I do not drink alcohol to cope; I am in a stable psychosocial situation, my own (rented) unit with my husband.
I feel that as more research is done, early intervention psychosis might advance so that psychosis can be prevented rather than treated.