FriendsArmsAroundEachOtherVirtual teams will strengthen early intervention efforts to ensure care is available to all who need it

A program that uses telemedicine and partnerships with local community mental health centers now in development at The Ohio State University Wexner Medical Center and the Ohio State Department of Psychiatry and Behavioral Health will help make specialized treatment for first-episode psychosis available in all Ohio counties by summer 2023. The program is expected to reduce the duration of untreated psychosis and dramatically improve outcomes for young mental health patients in the state.

It’s well established that psychosis treatment is most effective when started soon after symptoms appear. This is why, in 2015, the Ohio State Wexner Medical Center and the Department of Psychiatry and Behavioral Health established the Early Psychosis Intervention Center (EPICENTER), a mental health program that offers comprehensive behavioral health services and personalized care to youth and young adults in the Columbus area exhibiting early signs of a psychotic disorder. The medical center also helped community mental health centers launch similar programs in 16 central and southern Ohio counties.

Yet even though Ohio is among the national leaders in bringing early psychosis treatment to its residents, a majority of the 88 counties in the state don’t have local early intervention options for psychotic disorders. That will no longer be the case when the new program is up and running. Young people throughout the state will have local access at participating community mental health centers to the same care that patients receive at EPICENTER, and it may change the trajectory of their life.

“If you offer the right services early, before these illnesses have time to do their damage, we see youth and young adults just launch in their recovery,” says Nicholas Breitborde, PhD, director of the Early Psychosis Intervention Center at the Ohio State Wexner Medical Center. “This will be a game changer. There’ll be no one who won’t have access to specialized, early intervention services for psychotic disorders.”

Coordinated specialty care for all of Ohio

The new program is funded through a two-year, nearly $1.1 million grant from the Ohio Department of Mental Health and Addiction Services. It will operate under the coordinated specialty care model and serve people ages 15 to 35. Patients will receive case management, assistance with lab work and medication, and help with work and school through providers at brick-and-mortar mental health centers in their home communities. These services require in-person contact and knowledge of the local landscape, according to Breitborde, who is also a professor in the Department of Psychiatry and Behavioral Health.

Medication management, psychotherapy, and family education and support provided by Ohio State EPICENTER clinicians will be offered via telemedicine. Access to these services will be facilitated through a care coordinator located at the participating community mental health center.

“There were a lot of challenges that came out of COVID-19, but one of the benefits that occurred was that it made us all have to learn how to deliver care using telemedicine,” Breitborde says. “Now that that barrier has been crossed, we can leverage our new telemedicine skills to expand access to care throughout Ohio.”

Local providers and the team at the Ohio State Wexner Medical Center will work together closely to manage each patient’s care. Currently, officials are establishing legal, financial and communication protocols and procedures. The goal is to initiate services in two Ohio counties by July 2022, in what will essentially be test cases. If all goes according to plan, the remaining underserved counties in Ohio will come on board in the summer of 2023.

According to Breitborde, he gets calls weekly asking about treatment options from people in areas where there isn’t a first-episode program. In counties with a small population, the volume of psychosis cases may not financially support a stand-alone early intervention program, but a virtual operation serving multiple counties makes needed services available to many.

“When we expand out to all counties in Ohio, I wouldn’t be shocked if we’re providing access to 100 individuals a year who may otherwise not have had access to coordinated specialty care,” Breitborde says.

Early intervention leads to dramatic improvement

Ohio State has published extensively on the positive outcomes of people who receive care through its EPICENTER. In the first six months of treatment, patients, on average, experience:

  • A reduction in symptoms of psychosis
  • Better quality of life
  • Decreased substance use
  • Improvements in anxiety and depression
  • Increased cognitive ability and social functioning
  • Reduced need for high-intensity medical services, including emergency department visits and hospitalizations

When patients get the right care, and they get it early, recovery is not only possible, according to Breitborde, it’s the norm.

“Not surprisingly, because of all of the positive clinical outcomes experienced by people receiving EPICENTER care, combined with people getting back to work and school and staying out of the hospital, this care model saves a lot of money,” Breitborde says. “In that first six months of care, on average, we shave off between $16,000 to $20,000 per person in the cost of their mental health care.”

Breitborde intends to compare outcomes in the new program with those of other brick-and- mortar programs in Ohio as well as to those of the EPICENTER.

“I think it’s reasonable to think that we’ll see similar positive outcomes on these hybrid teams as we do on the in-person teams,” he says.

Fulfilling the mission of The Ohio State University

The new program brings a focus on prevention to psychotic disorders, a focus that has all too often been lacking when it comes to mental health, according to Breitborde.

“Many other fields of medicine have moved to more preventive approaches,” he says. “Unfortunately, mental health care has been relatively slow in embracing preventive care. We wait until some crisis emerges before care is provided rather than working to prevent these crises from occurring in the first place. That’s an approach that leads to poor outcomes and high costs.”

“A model like what we’re doing here at EPICENTER — that’s about catching psychosis early and preventing challenges rather than waiting for negative outcomes to occur and then trying to correct them — aligns with the goals and visions of Ohio State,” he says.

One of those goals is to make life better for all Ohioans.

“I think there is an ethos here at Ohio State of wanting to do great things, but not just limiting our goals and vision to the confines of our campus,” Breitborde says. “As a land-grant institution, our priority is to serve and improve the state that we’re part of.”

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