First Contact: Early Treatment for Patients with Symptoms of Mental Illness

Northwestern Medicine
Psychiatry and Psychology December 10, 2012
Will Cronenwett, MDMental health issues carry great morbidity (rates of illness) as well as high social costs such as long-term disability. Young people in the early phases of mental illness are particularly vulnerable. Northwestern Memorial Hospital addresses the needs of these patients through a program called First Contact, administered through the Stone Institute of Psychiatry. First Contact provides assessments and treatment to young adults (18-26 years old) who are within the first two years of the onset of psychiatric symptoms. The program draws on the support of physicians, psychologists, social workers, case managers, and occupational therapists, all of whom provide individual and group treatment.

Northwestern Memorial Foundation recently spoke with Will Cronenwett, MD, medical director of Outpatient Psychiatry at Northwestern Memorial and head of First Contact, to learn more about the program’s dual mission to strengthen clinical care and to conduct research about patients in the early stages of mental health issues.

Q:  First Contact was created in the fall of 2011 and has had steady patient referrals from the beginning. What else has the program achieved during its first year?

A:  In patient care, we’re moving from a focus on rehabilitating a patient after years of illness to a focus on prevention and early detection of mental illness before a formal diagnosis has been established, which can take months if not years and can result in extensive disability. This change in emphasis is unique to Northwestern. At the first presentation of symptoms, our team works together to identify individual strengths and risk factors in each patient. This helps us to control symptoms early on, sometimes even before a final diagnosis.

We’re making progress on the research front, too. Funding from the Chauncey and Marion Deering McCormick Foundation allowed us to launch the Chicago Adolescent Longitudinal Study (CALS) in partnership with the Warren Wright Adolescent Center. This study is designed to improve the understanding of the risk factors associated with serious mental illness in adolescents and young adults. Right now, we’re analyzing early data that show how the brains of individuals who are in the early stages of an illness are different than those who are not. The data also show how the amount of symptoms an individual shows relates to the activity and structure of their brain.

Patient care and research are closely related through First Contact. The goal of both is to keep people in their existing environments—or return them to those environments quickly as possible—and to help them to make progress on their life goals such as schooling and career, while also striving to keep their relationships intact.

Q: What is the patient’s experience in First Contact?

A: Our goal is for each patient to have the most pleasant experience possible right from the beginning. When we accept a patient who fits the criteria for First Contact, they first receive a thorough diagnostic evaluation. From there, they meet with an attending physician, and then are admitted to our clinic for further diagnosis and treatment, which can begin immediately, to alleviate their symptoms. Over the next two to three weeks, the patient undergoes testing to ascertain their level of cognitive functioning, such as their ability to plan and weigh alternatives and to process new information. We also assess each patient’s personality—their ability to handle frustration, their sense of self, and other areas that will help guide their treatment.

Occupational therapy assessments and treatment are crucial for our patients. For example, our OTs (occupational therapists) evaluate and help patients in their broader role functioning, such as their abilities to maintain daily activities and relationships. The OTs also reinforce their current hobbies and interests to help them maintain a sense of accomplishment and connection to the world. Occupational therapy becomes the gateway to other groups, one example of which is the social cognition group which helps patients read social cues and interact appropriately with others.

After a patient is released from the clinic, they continue to see a psychiatrist who monitors their progress and prescribes any necessary medication. Patients also might continue to attend therapy groups to help manage anxiety or depression. The support continues as they transition to traditional psychiatric care and progress toward life milestones such as college or a first job.

Q: Philanthropy helped fund the CALS project we discussed earlier. How else could donors help support First Contact?

A: There are several First Contact initiatives that would benefit from philanthropy.

We’d love to expand our community outreach and build relationships at local schools. Ideally, we would send a member of the First Contact team to work with the medical and administrative staffs at schools to educate them on identifying the early symptoms of mental illness and identifying at-risk individuals.

We’ve identified computer-based programs that help enhance brain function. The software requires a license for every patient that uses it. We’re also looking to convert our loan library of illness self-management books from paper to electronic books. These are examples of projects that have an immediate impact on patient lives.

To donate to First Contact, click here. For more information about philanthropic opportunities at First Contact or in psychiatry, please contact Rita Terterian, philanthropy director at Northwestern Memorial Foundation.

Check out these NM Care Areas:

You Might Also Like: