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A new challenge in mental health: Detecting psychosis before it begins

A Massachusetts nonprofit that encourages screening for mental illness is extending its work into a new arena — psychosis.

Screening for Mental Health, best known for such events as National Depression Screening Day, is launching an effort Tuesday to disseminate a new questionnaire intended to detect the precursors of psychosis, the condition of suffering from delusions and hallucinations.

“Psychosis is still an untouched, taboo issue,” said Candice Porter, vice president for outreach and partnerships at Screening for Mental Health. Yet about 3 percent of Americans experience psychosis at some point, the symptoms typically starting just as young people are emerging into adulthood. The goal, Porter said, is to “normalize the concept of assessing and actually getting treatment early.”


The nonprofit hopes to place the questionnaire on the websites of Massachusetts colleges, civic organizations, and other groups starting Tuesday and eventually roll it out in other states. It is available online at www.psychosisaware.org.

A psychotic episode is often perceived as a sudden break from reality that heralds a life of disability. But psychosis has warning signs, and specialists say that if treatment begins when those signs first appear, people often can stay in school, keep jobs, and sustain meaningful relationships.

“Early intervention is actually the best thing we can do,” said Dr. Dost Öngür, chief of the psychotic disorders division at McLean Hospital, who developed the questionnaire along with a team from other Harvard-affiliated hospitals. “Once a patient has been ill for some time, and has been through multiple treatments, the outcome is poor.”

People at risk of psychosis may have fleeting symptoms or odd sensations, such as feeling they are not in control of their own thoughts, or preoccupations with unusual things such Zodiac signs or fortune-telling, Öngür said.


The questionnaire asks about symptoms such as feeling not in control of ideas or thoughts; hearing strange sounds such as banging, clicking, hissing, clapping, or ringing; being confused about whether something was real or imaginary; or sensing that “others have it in for me.”

Such feelings can arise for a variety of reasons and do not always indicate severe illness. But sometimes they signal impending psychosis.

“People who are at risk tend to be help-seeking. They are worried that something is wrong,” Öngür said. But once they have full-blown psychosis, people typically believe they don’t need help and are less open to treatment.

Treatment for early psychosis includes low doses of antipsychotic medications, but the critical focus is a team providing an array of psychological and social interventions, Öngür said. Such care is more readily available in Massachusetts than in most other states, he said.

The new questionnaire will be introduced Tuesday evening at the Museum of Science at a kickoff event attended by state health care leaders. It will be available only in Massachusetts at first, and only at organizations that choose to offer it.

Founded 27 years ago, Screening for Mental Health has developed questionnaires that help people discern whether they may have nine conditions, including depression, anxiety, and post-traumatic stress disorder. People who complete the questionnaire are not given a diagnosis, but advised on whether they should seek an evaluation, and referred to local resources.

Colleges, YMCAs, employers, and other organizations partner with Screening for Mental Health to disseminate its questionnaires through their own websites. Screening for Mental Health also places kiosks in public places, where people can answer the questionnaire at a computer.


Starting Tuesday, a 10th condition will be added. Titled “Concerned about unusual experiences or behaviors,” the Psychosis Aware questionnaire has two versions — one for relatives and friends, and one for the person experiencing the symptoms.

In Massachusetts, Screening for Mental Health has partnerships with 41 academic institutions, 43 community organizations, and 13 workplaces. Its MindKare Kiosks are located in the town of Hudson and at the MetroWest YMCA, with plans to install them at Framingham State University and Franciscan Children’s, a Boston treatment provider for children with complex mental and medical needs.

“We have these existing relationships,” said Norm Gorin, chief executive officer of Screening for Mental Health. “Our task will be to make them all aware the new screening tool for psychosis exists, and talk to them about turning it on.”

Joan Mikula, the Massachusetts commissioner of mental health, said she looks forward to the day when people will take a mental health screening as readily as they stick their arms in a pharmacy’s blood pressure machine while waiting to fill a prescription.

The state is using a federal mental health block grant to educate health care providers about the symptoms of early psychosis, Mikula said.

Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.