My county, Lane County, Oregon, is one of a number of places around the country just starting to participate in a new “early intervention” program sponsored by NIMH, called RAISE, that says it aims to help people soon after they begin experiencing their first psychotic episode. While there are some good reasons to offer help to young people as soon as they start having problems that might be labeled psychosis, I have serious doubts about the program here being offered.
For one thing, the very name of the program (RAISE stands for “Recovery After an Initial Schizophrenic Episode”) suggests the program will be reckless in applying labels and stigma. Even the DSM cautions against calling a psychotic episode “schizophrenia” unless the mental health condition has lasted at least 6 months, but people will be recruited into the RAISE program as soon as possible after their problems with psychosis begin, a much shorter time period. Nevertheless, just due to the name of the program, they will feel defined as having had a “schizophrenic” episode.
Second, the NIMH website advertises that the program involves “intense and sustained pharmacological intervention.” This implies a reckless use of medication as well as of labeling. (Of course, the two go together – the sooner a person is labeled with “schizophrenia” the more justification can be made for “intense and sustained” drugging.)
Early intervention programs that really aim to help are very cautious about the use of both labels and drugs. The lack of caution in the design of this program suggests that the true purpose of the program is the early recruitment of young people into a life as labeled consumers of psychiatric medication. Tobacco companies have to recruit their own customers, but pharmaceutical companies have government assistance in capturing their market.
It’s interesting that an old friend of mine, John Bola, did a review of all the studies that ever compared programs that started people out on drugs immediately, with programs that didn’t, and where the comparison period was at least a year. You can read his paper here. What he found was that in each case, the program that didn’t rush people into drugs did better – and that was before taking into account the fact that the people not on drugs didn’t have to deal with drug side effects. And of course the best effects reported for an early intervention program are those of the Open Dialogue program, which also avoids using drugs wherever possible.
I wait for the day when we will treat young people with “psychosis” based on the evidence, and not based on the wishes of those more interested in profit.