According to the American Psychiatric Association, over half of people experiencing mental illness don’t receive clinical help and some avoid treatment due to fears of the attached stigma. Individuals experiencing first-episode psychosis frequently go undiagnosed, coping with untreated conditions for months or even years. Current care methods are scattered, and aren’t always centered around the individual.
The University of Minnesota Physicians (M Physicians) St. Louis Park Clinic NAVIGATE Program is changing the model for psychosis therapy through a clinically proven approach focused on resiliency and recovery. Melissa Dalhoe, LICSW, NAVIGATE Program director and family therapist, has credited the program’s success to its integration of a novel “coordinated specialty care” framework.
“NAVIGATE is a multidisciplinary approach to treating first-episode psychosis and schizophrenia spectrum disorders,” Dalhoe said. “The NAVIGATE model came out of the Recovery After Initial Schizophrenia Episode (RAISE) study back in 2009, which compared this team-based, coordinated specialty care approach to care as usual, and found that the team-based approach resulted in better outcomes.”
The program’s team-based model stands out from conventional care, which might include going to a variety of mental health professionals at multiple clinics. TheNAVIGATE program is one of three sites in Minnesota that receive grant funding from the Department of Human Services (DHS) to administer cooperative care with an emphasis on family support as a crucial component of recovery. The program offers tools for self-care during what can be a tumultuous journey for both patients and family members.
“I think another unique aspect of the program is the family support we offer,” Dalhoe said. “It's not typical for clinics to have support groups for families experiencing first-episode psychosis. Currently, we are recruiting for and researching the potential benefits of a positive psychology group intervention for caregivers with the goal of enhancing coping and resilience. Initial feedback from group participants has been promising.”
The program’s supported employment and education specialists, Craig Chapman, CESP, and Melissa Rosewall, LGSW, recognized the need for social outlets for individuals supported by the program, especially during the pandemic. To fill this need, they spearheaded virtual drop-in groups for NAVIGATE and Riverside Psychiatry Strengths Program patients aimed at developing self-awareness with peers and better supporting patient care. The weekly, no commitment drop-in sessions have gained traction.
“Most drop-in sessions cover mindfulness practices, current events, employment and education topics, games and a general safe space for banter amongst peers with similar lived experiences,” Chapman said.
To date, over 40 of the program’s participants have attended these sessions.
“Through conversations in this setting, we recognized the many artistic talents of the individuals we support, and applied for funds through the University of Minnesota Foundation to create and print an art and poetry chapbook that highlights how art, poetry and music intersect with mental health,” Rosewall said. “We are hoping to publish the book at the end of this year and look forward to more creative ways to highlight the talents and skills of those we support.”
In tandem with community support, Dalhoe highlights the importance of early diagnosis for individuals experiencing psychosis.
“There’s research and data demonstrating that the sooner the intervention, the better the outcome,” Dalhoe said.“We want to work with people as early as possible because we want them to have the best chance of recovery, and we know that recovery is possible. There’s a lot of hope in this model and if we can get connected with them sooner rather than later they’ll have better outcomes.”
Measurement-based care also plays a major role in the NAVIGATE Program. The program is backed by a research project called the Early Psychosis Intervention Network, or EPINET, which allows patients to understand and track their symptoms and functioning through measured analytics.
“We know that individuals and families find it really validating, normalizing and helpful to get data points that describe how they’re faring and then track that over time,” Dalhoe said. “It's really amazing, for example, to be able to tell somebody who is reporting cognitive difficulties that, ‘It seems like processing speed is lower than other individuals who fall in your age category.’ It can be incredibly validating to them to be able to hear that.”
While the unique program is in demand, NAVIGATE is most focused on getting people the care they need as soon as possible, a process that requires support from the entire community.
“We’ve done some community education and I think providers and family members are increasingly able to identify that someone’s experiences might fall into the category of psychosis and might benefit from our services,” Dalhoe said. “We accept referrals from anywhere and everywhere. What’s most important is that we have an open pathway for people to access care.”