Early intervention key to treating mentally ill teens

Nov 15, 2011

The research is clear that the key to keeping a mentally ill teen in treatment and out of trouble is early intervention. Yet, most counties in the Northwest do not offer comprehensive treatment to kids in the initial stages of a mental breakdown.

Early warning signs

Karen Howard says she knew her nephew was in trouble from an early age. As young as five he started lashing out... way more than other kids.

"By the time he was ten, he was hearing voices,” she says.

Howard and her family only want us to use her nephew's first name, which is Eric. She says as Eric's symptoms became increasingly obvious, "people would step back."

Literally step back.

"It was like something came out of a horror story,” she says. “'You can't be with us because we are normal people. You hear voices, therefore you're over here.' They didn't understand."

And the people who should understand -- school and medical professionals -- Howard says they initially brushed over the problem. Eric was diagnosed with ADHD and put on medication.

But then he set a garbage can on fire. He wrote a threatening letter to a classmate. He became addicted to drugs.

Howard says Eric should have spent those teenage years getting treatment for his mental illness. Instead, he was in and out of the juvenile justice system.

"Eric has been in so much pain in a box in his mind that he does not know how to communicate. And people don't know how to respond and to communicate to Eric on a level saying, ‘you are okay.’"

Early teen years are a critical time

Eric is now 24 years old and his life is still a mess. He's spent half this year in the Multnomah County Jail.

"Could Eric actually have been more functional? We don't know, because we didn't get those services," Howard says.

Experts say the early teen years are a critical time for diagnosing and treating mental illness. In fact, half of all serious mental health disorders are diagnosed by age 14.

Early intervention is the hallmark of one Oregon program that’s produced dramatic results by getting to kids as young as 12. It’s called the Early Assessment and Support Alliance (EASA).

And its counselors are winning the praise from Chris Bouneff . He’s the director of the Oregon branch of the National Alliance on Mental Illness.

"If you look at what results they've produced, you have clients served, kids served, who go on to have productive lives,” Bouneff says. “They finish school. They go to college. They get jobs. They do things that in the past, we didn't think were possible."

And Bouneff says it’s cost effective in the long run, because it keeps the Eric’s of the world out of more costly juvenile jails.

The typical approach, a bad outcome

But as Eric’s story shows, not everyone is getting those services. In fact, Bouneff says Eric’s experience is far more typical of the way Northwest states deal with mentally ill youth.

"Our system is: You get in trouble, you get expelled from school, you encounter law enforcement. You become such a disruption that the system has no alternative but to respond."

The statistics bear that out. According to the Oregon Youth Authority, two-thirds of the young people in its system have a serious mental health disorder. And that’s in line with national figures.

The aim of the Oregon-funded early intervention program is to identify and treat young people in the initial stages of psychosis. Tamara Sale directs the EASA office that serves Salem and the surrounding area. She says the traditional approach to early diagnosis often scares people away from further treatment.

"Often what happens is somebody will come in, they'll meet with somebody, the first thing they'll hear is 'You have schizophrenia, this is a chronic condition, you're going to need to deal with this for the rest of your life,'” Sale says. “And they never want to come back again."

Taking a different approach

Sale says EASA takes a different approach. Mental health professionals with the program often go right to the youth’s home. They try to develop a relationship with the teen, focus on their strengths.

Later the conversation might turn to how the mental illness is interfering with the kid’s ability to do the things they like. Then clinicians develop a personalized treatment plan.

Abdullah al-Masri says this approach was just the thing he needed for his mental illness. Al-Masri's father is from Lebanon but he was born and raised in Oregon. He agreed to tell me his story at a Middle Eastern restaurant near his home in southwest Portland.

"I like the kabobs, the beef kabobs,” al-Masri says. “They serve lasagna. I don't know why they serve lasagna, but they do."

The kabobs are comfort food for al-Masri. And he could use some comfort. He says a few years ago in his late teens he developed intense feelings of paranoia.

"I just stayed at home all day long and didn't want to go out, didn't want to socialize with anybody," he says.

Then came the voices in his head. They weren't friendly voices, either.

"’We're out to get you, we're going to get you.’ Stuff like that,” al-Masri explains. “This feeling that somebody's going to be down your neck and just kind of like pounding like you're not safe, stuff like that. It's really kind of scary and overwhelming."

Al-Masri says a hospital outpatient center hooked him up with EASA this summer. He's met with doctors, counselors, an occupational therapist visits him in his home. He spends time with other young adults trying to overcome the symptoms of severe mental illness.

And he’s even had a little fun.

"We went bowling a couple of weeks ago,” he says. “And I've been trying to go to groups every week. And I just try to be active them. They're a very great group."

Watching for missed opportunities

But while EASA so far seems to be working for Abdullah, there's a twist to his story. It turns out, this is al-Masri's second bout with psychosis and paranoia. And the first time around two years ago, things got ugly. He showed up at his mother's house one night feeling desperate.

"At the time I was outside the house and I was kind of banging on the windows to let me in and talk to her. So she called the police," he says.

Al-Masri says after a brief confrontation an officer calmed him down and dropped him off at the emergency room.

"I did have some symptoms of mental illness but all they did was really tell me like okay, you're depressed, here have some Prozac and there you go,” he recalls. “So I wasn't really thrilled with them. They just kind of like pushed me away basically."

So he walked out of the hospital the next morning... 20 years old, with no place to go. Mental health experts say that was a missed opportunity... the kind of moment that should have triggered an early intervention.

The EASA program is available to about 60 percent of Oregon's population. The Oregon Health Authority presented a plan to lawmakers this year that would have extended early intervention services to the rest of the state, including un-served cities such as Eugene and Medford. But in a year that saw many social service programs cut, lawmakers decided not to expand this one.

Copyright 2011 Northwest News Network