Often, individuals experiencing an early episode of psychosis are hospitalized and medicated. It’s a relatively simple and cost-effective approach.
But is it effective? What are the long-term outcomes? And are there alternatives?
By funding the development of a small Burlington facility that offers non-traditional treatment for early-episode psychosis, the state of Vermont is examining these issues. Soteria Vermont is a proposed five-bed rehabilitation home in a supportive residential setting where residents would not be forced to take antipsychotic medication.
Pathways Vermont, a nonprofit human services agency that promotes community-based treatment solutions, is coordinating this project. Amos Meacham, project manager for Soteria Vermont, feels that hospitalization and medication, especially in the initial stages of psychosis, can have long-term adverse effects.
“That first point of contact that people have [in treatment] is so crucial when you’re talking about psychosis,” explains Meacham. “They’re often in a place of bewilderment and fear. It can be a scary experience for them and the people around them and the stigmatization process begins early.
“Soteria Vermont will give people a little bit of space and time to try to get to a place on their own, where they can develop their own internal coping mechanism and internal understanding of what this is.”
The program will have a full-time staff consisting of a director, house manager and after-care coordinator as well as four residential assistants, a part-time psychiatrist and a naturopathic doctor. Meacham expects the average length of stay to be about three to six months and that most residents will be in their early 20s (when early-episode psychosis generally occurs).
There will be no rigid structure in the day-to-day routine, allowing for individual needs and capabilities, but arts and crafts, as well as other activities, will be available. “We’re looking to have a diverse staff in terms of interests and personalities,” Meacham says.
Residents will spend supervised time outside the facility. The Intervale, a nature site, is a short walk from the home.
Funding for the program is through a grant from the Vermont Department of Mental Health. Residents will not be billed for services, although there is a possibility that a sliding scale approach may be taken in the future.
Pathways Vermont is projecting a springtime launch. A site has been chosen in Burlington’s Old North End but before any work takes place or staff is hired, the Soteria application, submitted in late October, must be approved by the Green Mountain Care Board (GMCB).
HowardCenter, a regional mental health agency, has received “interested party” status from the GMCB and has aired some concerns about the potential impact of this new program.
“Our request for interested party status is not a statement of opposition,” says Bob Bick, LADC, director of mental health and substance abuse services at HowardCenter. “We needed more clarity on some issues so we understand how our two organizations can work together collaboratively.”
Some of the issues include how the two facilities would make referrals to each other, the handling of crises and whether Soteria Vermont would be available to out-of-state residents.
“It’s not our intention to hold up the process,” Bick says. “I don’t imagine that this is going to be more than a month or month-and-a-half in terms of us getting resolution on the questions and concerns that we have.”
Once the application is closed, the GMCB will evaluate the information. If the project is authorized, a waiting period and public hearing would follow. When final approval is granted, the building renovation will take about four to six weeks.
Meacham is confident that it will be worth the wait. “This program provides choices for people who feel that a lot of the mainstream treatment options are not helpful or don’t speak to their experience,” he says.
By Howard Newman