Most of the three million people suffering from schizophrenia in the U.S. get a similar treatment regimen: powerful drugs that mute voices and end hallucinations, with sometimes serious side effects.
But a major new study published today in the American Journal of Psychiatry shows that a different approach, one that includes more talk therapy and lower doses of medicine, and starts sooner, is far more effective at treating the disorder.
It could revolutionize treatment of a disease that disproportionately affects teens and young adults, and it could mean more people with mental illness receiving the effective treatment they need. About half of recent mass shootings in the country have been perpetrated by people who face untreated mental illness, mostly schizophrenia, according to psychiatrists.
The study, which has been in progress for seven years, covered 22 states, 36 health clinics, and more than 400 people dealing with a first episode of psychosis—when they experienced hallucinations or another break from reality for the first time.
A control group of patients received the usual schizophrenia treatment, typically a course of medication. Another group of patients were put on a new program: They received low doses of drugs but also had a team of specialists who provided them with talk therapy, a case manager, and help with school and work. Family members were encouraged to join in with the treatment, and the patients themselves were consulted and involved at every step of the way.
Over the course of two years, the patients enrolled in the new program stayed in treatment longer, saw more dramatic improvement in their symptoms, and reported better interpersonal relationships, quality of life, and involvement in work and school than the patients receiving typical care. The most exciting part is that these results came not in a lab but in a real world setting, with actual patients coming to actual mental health clinics around the country.
"Most studies, they start in more highly controlled research environment and then there's a very incremental progression out into the community," Dr. Robert Heinssen, a National Institute of Mental Health psychiatrist who oversaw the research, said in an interview. The study's purpose was to "leapfrog that process" and create strategies that mental health professionals could start using today.
"It's a beautiful balance of scientific rigor and real world practicality," he said.
Schizophrenia is something that especially affects the young. The mean age of study participants was 23, and about 75% of adults with mental illnesses, including schizophrenia, have their first episode before age 25. The longer it goes untreated, the more affected you are for the rest of your life.
"We need to be getting there much, much earlier, as close as possible to the onset of psychosis," Heinssen said. "If we do, we can help them rapidly get back to school or rapidly get back to work."
If the study's recommendations for treatment are widely taken up, it could also mean less people suffering from the side effects of schizophrenia drugs, which include emotional numbness, drowsiness, restlessness, muscle spasms, and weight gain. The patients under the comprehensive form of treatment received doses 20 to 50% lower than normal.
Thomas Insel, the director of the National Institute of Mental Health, called the new treatment program a breakthrough at a panel at Chicago Ideas Week on Sunday. He noted that the new study found that the mean amount of time between someone having a first episode and getting treatment—a major factor in how well they improve—was 74 weeks.
"That is just egregious," Insel said. "It's incredible that in 2015, kids are sick, they're very sick, potentially a danger to themselves and others, a year and a half before they're getting a diagnosis."
"We just need to put a laser-like focus and figure out how do we get there earlier, intervene earlier and actually prevent psychosis," he said.
There are already encouraging signs that the new treatment described in the study is becoming more broadly available. Congress sent the states $25 million in 2014 to put to use for evidence-based mental health programs that target early development of mental illness—just like this study describes. And the Centers for Medicare & Medicaid Services recently announced it would support this kind of treatment.
For elected officials concerned about continued drumbeat of mass shootings, expanding treatment that's been proven to work could be an effective response that doesn't offend Second Amendment fanatics. "When people are getting treatment for their serious mental illness, their risk for the kind of violence that we've seen in the newspapers really reduces to the same as the general population," Heinssen said.
Advocates say transforming this treatment from new to commonplace will improve the lives of millions of people suffering from schizophrenia—and signal a break from the traditional American response to mental illness.
"We minimize the severity of these problems over and over again and assume that they’re just moral failings, they’re behavioral problems that you just have to snap out of it," Insel said. "We don’t do that for cancer."
Univision, one of Fusion's parent companies, is a sponsor of Chicago Ideas Week.
Casey Tolan is a National News Reporter for Fusion based in New York City.