(WITHDRAWN) Psychosis Prevention Outside of the Psychiatric System

The past decade has seen the rapid expansion of early intervention services for psychosis in the United States. Perhaps the most hopeful but also most controversial of these approaches has been the development of the "clinical high-risk for psychosis" or "attenuated psychosis syndrome" concept: the idea that we may be able to identify the antecedents of psychotic disorders among help-seeking youth, respond with intensive short-term psychosocial interventions, and thereby prevent the onset of schizophrenia and other psychotic disorders. The hopefulness lies in the possibility of drastically altering someone's life trajectory by intervening at a critical time in the development of mental health symptoms. The controversy, however, lies in two assumptions: (1) that the application of a psychosis-risk label will be stigmatizing and that the harm of such a label may outweigh the benefits of treatment, and (2) that psychiatrists may take a risk-averse (and liability-averse) approach to an attenuated psychosis diagnoses by prescribing anti-psychotic medications, despite clinical guidelines recommending against their use in this population.

These potential drawbacks of preventive psychosis services can also be considered an opportunity: what if we remove the risk of stigma, and the risk of over-medication, by providing person-focused and recovery-oriented services outside of the psychiatric system? The development of such approaches has been proposed as a Grand Challenge of Social Work under the Ensuring Health Development for All Youth initiative, yet remains in very early stages of conceptualization and implementation.

The purpose of this roundtable session is to discuss clinical issues faced by youth meeting clinical-high risk criteria, to unpack the potential need for alternative (i.e., social work based) models of preventive mental health care, and to address potential logistical issues in the implementation and delivery of such services. Presenters will provide an overview of clinical high-risk research and services to date and discuss alternative models of service delivery that may effectively meet the needs of this population. One presenter will discuss preliminary efforts to address psychosis prevention through the Grand Challenges initiative, with an emphasis on current efforts to develop community-based approaches to early intervention. Another presenter will discuss the potential for engaging social relationships in the prevention of the onset of psychosis. Another presenter will look at the role of creative peer support models offering alternative visions to the biomedical framework of psychosis and the potential for collaboration inside and outside of the public mental health system. The fourth presenter will consider ways to promote a learning exchange between youth and providers, as an avenue to more fully understand and address the barriers and facilitators to effective care and intervention. Our goal is to involve the social work research community as we work through these big-picture questions and envision new ways of approaching preventive mental health work to ensure the healthy development of transition-aged youth.