The leadership of PEPPNET acknowledges and condemns the systemic racism against the Black community inherent in American society. We also acknowledge the racial bias and cultural insensitivity apparent in the lack of appropriate access, support, and treatment for Black, Indigenous and People of Color (BIPOC) community members across our mental health system. We are grateful that these long-overdue national and international conversations on race and racial injustice are beginning to occur. As a mental health community, it is incumbent on us all to learn about, prevent, recognize, and address racial discrimination across all clinical and research settings and within society as a whole. We know that we have much to learn and need to do better. PEPPNET needs to better represent diverse voices within the network, to listen to individuals from diverse backgrounds, to learn from the rich narratives that doing so can bring, and address the impact of social injustice, stigma, racism, and trauma on mental health. We are actively forming collaborations to address these needs and welcome any feedback, suggestions, or ideas from our network members on how to improve the capacity of PEPPNET to address racism and meet the mental health needs of our Black and Indigenous communities and all People of Color.

 Each model component provides specialized assessment and treatment for early signs of serious mental illness, making significant impact on the lives of individuals and families. .Since 2018, Felton Institute began implementation of (re)MIND^® Alumni, a new pilot to support young people and families transitioning out of early psychosis coordinated specialty care. Together, the Felton early psychosis programs provide a full array of early psychosis prevention and treatment through rigorous implementation of evidence-based practices, with measured program outcomes and community impact.

In April of 2014, Felton Institute received the prestigious 2014 Inspiring Hope: Science to Service Award by the National Council for Behavioral Health for “inspiring hope, advocacy, leadership, and impact in the field of mental health,” recognizing the Felton Early Psychosis Model as one of the prominent early psychosis coordinated specialty care models in the United States.

The Felton early psychosis programs – (re)MIND^®, BEAM, Felton BEAM UP^®, and (re)MIND^® Alumni – are community mental health outpatient clinics offering individual psychotherapy (cognitive behavioral therapy for psychosis), research-validated structured diagnostic assessments, person-centered treatment planning, algorithm-guided medication management, family support, individual and family psychoeducation, supported employment and education services, care management, and peer support. With sites in the San Francisco Bay Area (San Francisco, Alameda, San Mateo and Marin Counties) and California Central Coast (Monterey County), the (re)MIND^®, BEAM, and BEAM UP^® programs serve approximately 350 individuals each year.

With an interdisciplinary team of therapists, employment and education specialists, family and peer support specialists, psychiatric nurse practitioners and psychiatrists, the Felton early psychosis programs promote community outreach and education activities, group meetings and field trips, family orientation sessions, graduation ceremonies, and other activities to support recovery and well-being. If you would like to learn more about Felton Institute’s (re)MIND^®, BEAM, BEAM UP^® or (re)MIND^®Alumni, please visit http://www.feltonearlypsychosis.org or contact Adriana Furuzawa (Felton Institute Early Psychosis Division Director) at afuruzawa@felton.org.

Written by Adriana Furuzawa

In October, 2019, PEPPNET entered into a new partnership with the American Psychiatric Association (APA) and SMI Adviser in offering educational webinars on topics related to early psychosis, with a focus on front-line clinicians. An initiative of APA, and funded by the Substance Abuse Mental Health Services Administration (SAMHSA), SMI Adviser is a clinical support system that provides education, data, and consultation for clinicians, and guidance and resources for individuals, families and friends caring for someone with a serious mental illness. The monthly webinars offer content on a wide range of topics relevant to early psychosis, and continuing education credits will be offered for physicians and psychologists, as well as a certificate of participation for all webinar participants upon request.  

Webinars for 2020 have included Strategies to Improve Supported Employment and Education (SEE) Outcomes in Coordinated Specialty Care (CSC) for First Episode Psychosis, by Shirley Glynn, Ph.D.; Peer Specialists within OnTrackNY:  A Unique and Dynamic Role, by Abaigeal Duke and Danny Sosa; Screening for Psychosis in Adolescents: Considerations of the Knowns and Unknowns, by Kristen Woodberry, Ph.D., and  How Are Neurocognitive and Social Cognitive Factors Related to Daily Functioning in First Episode Psychosis? by Joseph Ventura, Ph.D.

We are excited to be working with the SMI Adviser team and look forward to providing quality education and learning opportunities to the early psychosis community.  For information about future PEPPNET/SMI-Adviser webinars, please contact us to be added to the PEPPNET Listserv.

The COVID-19 pandemic has had a significant impact on not only the healthcare industry, but also our everyday way of life. As Donoghue and colleagues (2020) point out, social distancing measures put in place to reduce the spread of the virus have resulted in the closure of popular gathering spaces for adolescents and young adults. Additionally, anecdotal reports suggest that many individuals are avoiding emergency departments and doctor’s offices due to concerns about COVID-19 contagion. These changes may diminish the impact of the aforementioned EI public education campaigns and other strategies aimed at reducing DUP. The natural consequence of these issues may be increasingly longer DUP among certain individuals.

According to Donoghue and colleagues, if EI campaigns do not adapt to the current environment, it could result in a backlog of individuals grappling with prolonged DUP. The negative impact of this backlog will be further compounded by the fact that there will be the usual number of individuals experiencing FEP seeking EI, in addition to those who have delayed treatment. EI providers may struggle to adequately attend to all the needs of these individuals, as well as to adapt to the social distancing requirements in a way that still allows for comprehensive assessment and treatment.

Donoghue and colleagues (2020) suggest the following strategies to mitigate the disruption of EI campaigns due to the COVID-19 pandemic. First, they suggest that EI service providers should actively compare current EI referral rates to those at the same time last year. If there is a significant discrepancy between the referral rates, it may indicate that there is a need for increased educational campaigning and outreach. These campaigns should be adapted the novel environment imposed by COVID-19 restrictions. Donoghue and colleagues (2020) suggest methods like using television and digital media. They also suggest that EI service providers should make it easier to self-refer to EI services and otherwise remove barriers that may negatively impact access to care.

Donoghue and colleagues (2020) emphasize the importance of remaining flexible and creative in the provision of care, as well. They suggest that assessments and treatment could move to telehealth, if clinically indicated. Research suggests that telehealth can be an effective form of service provision, although providers will require additional training on how to adapt treatment to this unique format. Other forms of treatment could involve methods like online social therapy, mobile apps, and virtual reality. These new, creative methods of assessment and treatment will need to be carefully balanced with other forms of treatment that require in-person contact, such as the monitoring of the metabolic side effects of psychotropic medications. Finally, Donoghue and colleagues (2020) call our attention to innovative methods used to identify people who may be at higher risk for developing psychosis. They give the example of previous research that used social media linguistics to identify people with schizophrenia and those at risk for relapse.

The core message of Donoghue and colleagues’ (2020) article is that the EI Model of Care must adapt to the changes to the healthcare system and everyday life that are a result of COVID-19. In their concluding remarks, Donoghue and colleagues (2020) emphasize that EI services should not be neglected due to the demands put on the healthcare system as a result of COVID-19. EI services are not only cost effective, but also life-saving treatments for individual living with psychosis. As is represented in the suggestions made by Donoghue and colleagues (2020), adapting to this novel environment will likely require innovation and flexibility on the part of EI service providers.

Reviewed by Elizabeth M. Michael, M.Sc., M.S.

Diverse Thinking, Hearing Voices, and Connections
By Patrick Kaufmann

Many of us have been diagnosed with a psychosis-related disorder, though we don’t always view this as a detriment.  My personal struggle with voices has taken me on a journey from despair to happiness.  For me, and others who struggle with voices, there is hope for a positive experience whether our thinking continues to be diverse or not.  Perhaps if we examine the nature of our connections with communities, people we know, and voices, we can achieve greater control over our lives.

Already we have great attributes.  We are creative people.  Our out-of-the-box thinking can be enlightening to others. People that think like us make significant contributions to society.  Businesses have been known to seek out people who think like us because of our unique ideas.  We can be spiritual leaders among other things.  We have deep compassion and an ability to overcome adversity. 

I share with others the belief that all paths leading to diagnosis are ones of trauma and/or stress.  Hearing voices can be considered a dis-associative response to these events.  Tuning into other realities can be a coping strategy as well.   Such responses are often effective, but I have found that they can also lead to thoughts that I “can’t turn off”.  When we internalize negative messages from our environments we might turn inward.  Voices follow suit. 

When this happened to me, I felt angry.  Society seemed to reject me.  Friends were both good and bad.  My community feared me.  I lost faith in myself and I was angry at the voices, and they were angry back.  I became vengeful.  It was all a vicious cycle. I believed I was being persecuted and I was overcome by how “unfair” it all seemed. 

Overtime I have found a way to have some control over these relationships.  I’m not sure what happened first or if was all at the same time.  I made peace with my community.  I avoided the corruption of drug use and crime.  I tried to build up my friends and if they tried to bring me down, I kept them at a distance. Thankfully, I found that when I learned to value myself, I gained control over my life.  I got into the idea of helping others.  When I looked to help my voices rather than trying to hurt them like they hurt me they softened.  They even became child-like and I saw that they needed support.  The result was a healing experience.  The same voices that were once insidious, are now fun and a source of joy. 

Our individuality works to our advantage.  Our compassion is our way out of distress.  I think that if we embrace every part of ourselves, we can redirect our gifts into happiness with ourselves and the world around us.

In partnership with APA SMI Adviser and NIMH, PEPPNET is offering a virtual 'Advancing Early Psychosis Care Conference’ in the Fall of 2020. This will be our third annual conference. Through workshops, panel presentations, and interactive sessions, this conference will provide information, resources, and tools for frontline clinicians and other team members who provide care and treatment of individuals who are either at clinical high risk for psychosis, or experiencing first episode psychosis.

Conference registration will be announced through the PEPPNET Listserv.

Information from previous year's conference can be found at:https://med.stanford.edu/peppnet/events/second-national-early-psychosis-care-conference-in-the-united-st.html