Schizophrenia affects a little more than 1 percent of the U.S. population, but it’s much more prevalent among homeless persons. Estimates are wide ranging, but some go as high as 20 percent of the homeless population. That’s thousands of people living with schizophrenia and experiencing homelessness each day.
Nearly 10 million Americans suffer from a severe mental illness (SMI) – schizophrenia, bipolar disorder or severe depression. Schizophrenia is generally the most stigmatized of these three disorders, and can be the most burdensome. The symptoms, which include hallucinations, delusions and sometimes incoherent speech patterns, often make it difficult for people with the disorder to maintain relationships, access treatment, or keep employment or housing.
A new study of an intervention called Recovery after an Initial Schizophrenic Episode (RAISE) offers promising results for an early, comprehensive intervention for schizophrenia. The study examined outcomes for people treated with this intervention, which essentially consists of providing medication and psychotherapy along with case management upon the identification of a psychotic episode (ideally while the person is still experiencing first-episode psychosis or immediately after).
What makes this intervention different from previous treatment approaches is its response time and a decreased reliance on medication-heavy approaches.
The study showed that patients treated at a RAISE site experienced improved quality of life and increased employment and education. The study also indicates improved outcomes for housing retention.
Because of the intimate relationship between severe mental illness and homelessness, there are some exciting implications for the potential of an intervention like RAISE:
- Schizophrenia and other SMI are mental illnesses characterized by periods of psychosis or depression, and the study finds that the sooner patients began treatment (within or after the first episode of psychosis), the better they did. Early interventions can keep patients connected to treatment and meaningful relationships, and can prevent unemployment and homelessness.
- While outcomes are best for people who are treated after the first episode, RAISE could be the answer for people who haven’t responded to other treatments in the past or people who experienced multiple periods or episodes of psychosis. The Washington Post and New York Times recently reported the stories of a few patients who had lost hope until enrolling at RAISE sites for treatment.
- The RAISE approach incorporates components such as case management and supported employment that are common among effective homelessness interventions, notably Housing First. The approach addresses factors that contribute to a person becoming homeless, and it’s easy to see how it could reduce housing instability and homelessness among people with schizophrenia.
Like permanent supportive housing, this intervention is intensive and costly. However, researchers say it could prove cost-effective over time by reducing emergency department visits, in-patient stays, and justice system costs. Federal agencies have already issued guidance for states to access Medicaid and mental health block-grants for first-episode psychosis treatments. And significant mental health reforms are a hot topic in Congress these days.
We know we’re facing an uphill battle. Research indicates that about 10 percent of people who suffer a psychotic episode will be successful without treatment, but that 10 to 15 percent of patients will also be impossible to treat. For that 75 to 80 percent in the middle, RAISE seems like an encouraging option.