(May 21, 2019) For serious mental illnesses like schizophrenia, early diagnosis and treatment can be critical to long-term patient health. And while hospitalization for a person experiencing first-episode psychosis may be a necessary starting point, effective treatment also includes a continuity of care so gains from stabilization are not lost. New data from the New York City Supportive Transition and Recovery Team (NYC START) program for first-episode psychosis shows how case management with an emphasis on frequent personal contact can help maintain patients’ engagement with treatment, even after discharge from an initial hospitalization.
According to a New York City Department of Health and Mental Hygiene (DOHMH) analysis, in 2011, less than 60% of young adults hospitalized in the city for first-episode psychosis had a follow-up mental health appointment within 30 days of discharge. Nearly half (47%) of these individuals were re-hospitalized within a single year. To address these chronic re-hospitalizations and missed opportunities for treatment, DOHMH implemented a case management model of patient follow-up in 2014, designed to link individuals discharged with psychotic disorders to community services.
Whenever a person is admitted to a New York City hospital for first-episode psychosis, the hospital is required by city health code to notify DOHMH. Following discharge, the patient is connected with a group of social workers and peer specialists known as NYC START. Together, using a shared decision-making approach, the patient and NYC START team coordinate recovery services such as outpatient mental health and primary care, housing and employment assistance, and peer and family support for the first 3 months after discharge.
In a new analysis of 2016 NYC START data published earlier this month, researchers found a significant improvement in the rate of mental health clinician contacts for individuals discharged from the hospital after an initial episode of psychosis. Of 285 individuals enrolled in the NYC START program, 79% attended an outpatient mental health appointment within 30 days of discharge; a 20-point increase compared to 2011 outcomes before the implementation of the program. Almost as many (78%) continued receiving NYC START services for at least three months. Data also highlight the frequency of face-to-face and other interactions initiated by program staff, suggesting the importance of building consistent relationships between staff and enrolled individuals. By design, face-to-face contacts were highest during the first week after discharge, with an average of 1.5 successful meetings. And while the frequency of face-to-face meetings decreased over time, staff maintained relationships with active clients through other forms of communication, such as phone calls or email, throughout the duration of the program.
The researchers note that due to the unique nature and small staff size of the NYC START program, the results may not be entirely generalizable to a larger population. There was also no designated control group with which direct comparisons regarding program success can be made. However, according to the authors, the high proportion of individuals accessing follow-up care, combined with the limited number of individuals lost to drop-off, suggest the NYC START program has been successful in offering services valued by participants and fostering connections to community supports at a crucial time after experiencing first-episode psychosis.
References:
Elizabeth Sinclair
Director of Research
Treatment Advocacy Center