Peter’s Take is a biweekly opinion column. The views expressed are solely the author’s.
We’ve all seen mentally ill people on the street, often disheveled, perhaps speaking to no one in particular, seemingly unaware that they are ill and unable to care for themselves.
This may be the face of mental illness, but it shouldn’t be because recovery is achievable.
Recovery requires early detection of psychotic illnesses, followed by prompt and effective treatment to prevent the cognitive decline that occurs when psychosis goes untreated. Early intervention also prevents or limits substance abuse, involvement in the legal system, and other negative but all-too-common consequences of severe mental illness.
Early identification of psychotic illnesses
One highly effective program is Coordinated Specialty Care (CSC) for those with early episode psychosis (or First Episode Psychosis), a program based on extensive research with positive outcomes sponsored by the National Institute of Mental Health (NIMH).
In Northern Virginia, all of the localities except Arlington offer this evidence-based CSC model for teens and young adults experiencing early-episode psychosis. Arlington offers elements of this program, but it does not offer them in a way that adheres to the model and is intensive enough to effectively treat the most severely ill teens and young adults with schizophrenia or schizoaffective disorders.
Without CSC what does Arlington offer?
Arlington offers an array of programs, what one parent calls a “patchwork,” but not CSC for those with the most severe illness. These teens and young adults either go untreated, isolating at home, often frightened by their symptoms, and falling further behind their peers, or receive in-home services from Arlington’s PACT (Program of Assertive Community Treatment), essentially, long-term care.
We are unnecessarily jeopardizing the possibility of recovery when we place young adults in long-term care, declare them disabled, and consign them to a lifetime of poverty living on Social Security Income (SSI). These are often young adults who showed promise in school or other pursuits and who still have potential. Arlington should be offering a program that conforms to the CSC model for those teens and young adults who need these very intensive but short-term (usually two years) services built around a goal of recovery. Recovery is what families and ill young adults want and deserve.
Funding
Even though the CSC program is short-term, its low caseloads and intensive services are costly. Unlike Arlington, our Northern Virginia neighbors all offer CSC programs and receive ongoing funding from state and federal sources to help cover the costs. (Unfortunately, Arlington didn’t submit an application when those funding sources were first offered.) However, the consequences of NOT treating these teens and young adults effectively are also costly, in terms of arrests, incarceration, hospitalization, homelessness, poverty, and a lifetime of intensive service needs. This is why the Mental Health Subcommittee of Arlington’s Police Practices Group recommended (at p. 13) implementation of such a program to reduce the number of people with mental illness who fall into crisis.
As “Sandy,” an Arlington parent, explains:
My son is in his early thirties and has schizoaffective disorder. He received a bachelor’s degree in electrical engineering and worked as an engineer. Over the past 3 years his symptoms worsened resulting in over a dozen hospitalizations, arrests and incarcerations in Arlington. He is now homeless and receives SSI because he is disabled. If he’d had access to a CSC program my son would likely be in recovery, working and managing his illness. Now I fear what will happen to him and to the public’s safety.
It is also costly when we do not promptly and effectively treat those with severe mental illness.
Conclusion
Arlington should begin now to serve teens and young adults with schizophrenia with an evidence-based Coordinated Specialty Care program.
“We want our young adults with severe mental illnesses to learn to manage their illness so they can work in increasingly responsible positions. When we place a young adult on SSI, we are asking them to settle for less than they should,” says Naomi Verdugo, a NAMI family support group facilitator in Arlington for over 17 years.
Arlington cannot afford not to provide a CSC program. Recovery is achievable if only we provide one.
Peter Rousselot previously served as Chair of the Fiscal Affairs Advisory Commission (FAAC) to the Arlington County Board and as Co-Chair of the Advisory Council on Instruction (ACI) to the Arlington School Board. He is also a former Chair of the Arlington County Democratic Committee (ACDC) and a former member of the Central Committee of the Democratic Party of Virginia (DPVA). He currently serves as a board member of the Together Virginia PAC, a political action committee dedicated to identifying, helping and advising Democratic candidates in rural Virginia.