News

First in Nation Community-Wide PIER Project Designed to Stop Major Psychosis
(February 12, 2001)

Severe mental illnesses such as schizophrenia strike their victims in the prime of youth, with tragic consequences that are seen all to often in Maine and elsewhere. People with chronic, debilitating mental illness often suffer horrifically-alienated from society, unable to cope with the daily stress of living. Families are torn apart. And the burden on society is phenomenal: Research has shown that the estimated lifetime cost of caring for a single person with a severe long-term mental disability, including housing support, medical and psychiatric care, Social Security, daily living expenses, lost income and the financial impact on the family, is $10 million.

Now, there is hope for young people in the Greater Portland area who may be experiencing early signs of psychosis. Under the direction of William McFarlane, M.D., chief of the Department of Psychiatry at Maine Medical Center, the Maine Medical Center/Spring Harbor Hospital mental health system is leading a potentially important research project: the Portland Identification and Early Referral (PIER) program.

The project, which is the first in the nation to be modeled after similar successful and community-wide programs in the United Kingdom, Australia and Scandinavia, has the potential of halting the early progression of schizophrenia and other severe psychotic disorders. Funding for the project has been provided in the form of grants from the Unum Foundation and the Center for Mental Health Services of the Public Health Service and several local foundations and philanthropies.

"This project is based on a very simple idea: an ounce of prevention is worth a ton of cure," explains Dr. McFarlane. "There is increasing evidence that psychotic episodes physically damage the brain, which, if repeated over time, leads to profound, chronic disability. If we can prevent the onset of the psychotic phase of the disease, we may be able to stop that damage in its tracks. In addition, research has shown that younger people, with better brain plasticity, are much more sensitive to treatment. They and their families are also more willing to get help and are better able to fight the disability."

The three-phase program will begin with educating those who work most closely with youth. A team of highly trained mental health professionals from Maine Medical Center's Department of Psychiatry will reach out to physicians, schools and colleges, social workers, guidance counselors, high school nurses, police and other professionals who may encounter young people in the early stages of deterioration towards psychosis. The goal is to educate these individuals and other agencies that work with youth to recognize the early signs or active symptoms of major psychotic disorders and quickly refer those individuals as candidates to the PIER project.

The second phase is educating the community. Through a public information campaign to begin later this year, the Maine Medical Center/Spring Harbor Hospital mental health system aims to chip away at the stigma of mental illness by educating families, young people, and the general population about early warning signs of psychosis. The objective is to identify the illness as precisely that, and to begin treatment at the earliest possible stage.

For example, a parent may notice that her teenager is suddenly doing poorly in school. He may be withdrawing from social activities or complaining that he's being watched by his peers. He may be experiencing unusual body sensations-even such transient symptoms as hearing noises or seeing hallucinations. "If several of these symptoms are present together, there may be reason for serious concern and early treatment," notes Dr. McFarlane.

The third phase of the project is evaluation and treatment of at-risk youth, which can include a combination of family intervention and education, along with medication therapy, as necessary. "Working closely with the family is critical," explains Dr. McFarlane. "They see that something is terribly wrong and are desperate for help. We help them restructure the individual's routine to reduce stress, improve sleep and eating habits, enhance social interaction, support them in school or on the job, as well as offer them ongoing support, therapy and information."

How many people may directly benefit from the project? About three percent of the population is at risk for schizophrenia, major depression, or bipolar (manic-depressive) disease. This translates annually to about 75 people in the Greater Portland area between the ages of 12 and 30.

"These diseases last a lifetime; the stakes are high. Our goal is to identify and treat as many people as possible before they become psychotic, saving them from terrible suffering, offering them the promise of much greater fulfillment, and reducing the burden on their families and the community," says Dr. McFarlane.