PREP program for early psychosis receives funding boost

The Prevention and Recovery in Early Psychosis (PREP) program in Massachusetts has expanded its work to help diagnose and treat young adults grappling with the early stages of psychotic illness.

PREP, which provides intensive, comprehensive, evidence-based outpatient treatment for young adults 18-30 who are experiencing an early episode of psychosis, is a joint venture of the Outpatient Department at the Massachusetts Mental Health Center (MMHC) and the Commonwealth Research Center, affiliated with Harvard Medical School, and housed at MMHC.

The program, in operation for more than 10 years, is funded by the Massachusetts Department of Mental Health and has been increasing its services since it benefitted from a bump in funding in 2014, when SAMSHA allocated a five percent increase in state community mental health services block grants to be earmarked for early intervention efforts.

That first year, PREP grew the program by adding an employment specialist and substance abuse specialist to its primary location, but also expanded by opening a second location in the western part of the state – Holyoke – in 2015.

“We also just got verification of some good news, that the federal government this year has added another five percent, so now that’s 10 percent that every state is getting for 2016 to do even more with early intervention,” said Margaret Guyer, Ph.D., clinical and professional services, Massachusetts Department of Mental Health, who oversees the initiative.

With the new increase in funds, PREP will develop a strategic plan for how to increase capacity state-wide to do early intervention work, Guyer said.

“There’s a huge need,” Guyer said. “In Holyoke, the response has been amazing in that there’s a huge demand. They’ve done a really nice job.”

A major component of the Holyoke effort has been community education and outreach. “They’ve done a lot of going to college counseling centers, going to primary care doctors, working with different community groups to raise awareness about early signs of psychosis and raise awareness about the programs and solicit referrals.”

Guyer said PREP offers similar services to the national Recovery After an Initial Schizophrenia Episode model, but has additional components. “The additional components that I think are distinct about PREP are really the focus on the peer community. It has a very robust group program and peer milieu component to it, for both young adults and their families.”

In addition to offering strength-based and recovery focused group activities specifically for the young adults and their peers, PREP also utilizes multi-family group therapy. “It’s more than psychoeducation,” Guyer said.

“It really helps connect families with each other. The multi-family group therapy model is a problem-solving, conflict negotiation intervention, so it helps families learn the skills to negotiate difficult dynamics and issues as a family. Particularly with young adults – age 17, 18, 19 – that’s the time people are leaving home and becoming independent. Then they have an illness that requires often a lot of support and dependence on families. Navigating that tension takes a lot of work.”

The multi-family groups include the young person and his/her family, along with other young people and their families. “The families learn from each other,” she said. “It teaches families how to resolve conflict and problem solve. There’s a lot of empowering families to learn from each other and realize they have something to offer other families, as well.”

PREP offers cognitive enhancement therapy, which utilizes computer exercises and a social cognition therapy group, to help young people rebuild their cognitive skills.

“Because often, problems with attention and problems with looking at the big picture or getting the gist, or reading social cues and responding to people, can be difficult for people experiencing psychosis,” Guyer said.  “So that’s one of the treatments that is available to people that has a really solid evidence base behind it and has been found to be very helpful in helping people get back to work and get back to school.”

PREP is focused on helping young people get back on track developmentally as quickly as possible, whether that means back to school or work, or expanding their community relationship. Guyer said it’s more the norm, than the exception, for young people who participate in PREP to start taking classes, volunteering, working or joining community activities.

Guyer points to data that shows the shorter the duration of untreated psychosis, the better the prognosis over time. “One of the goals of the program is to get people back on track in their community and living full lives,” she said. “The more you can get young people working, in school, maintaining relationships – that affects their whole ability to live with this illness and experience less functional impairment.”

Guyer said one of the program’s goals is to help increase capacity state-wide, by sharing their expertise to help other providers properly recognize and treat psychosis, and by helping other programs across the state provide better employment and education services, as well, to meet the demand for these services.