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New Maryland mental health initiative focuses on identifying and treating psychosis

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Dr. Gloria Reeves (left), psychologist Jason Schiffman and Dr. Robert W. Buchanan work for the new Clinical High-Risk program. It's part of new state-sponsored mental health center that seeks to treat individuals with psychosis.

One day last summer, a former Navy reservist phoned police in Newport, R.I., to say someone was using a "microwave machine" to send vibrations through his body to keep him from sleeping.

Six weeks later, the same man took a shotgun into the Washington Navy Yard, began firing and killed 12 people, including himself.


Judging from details in the Rhode Island police report, mental health experts say the shooter, a civilian contractor named Aaron Alexis, was likely wrestling with psychosis, a symptom of mental illness associated with a higher-than-usual risk for violence.

The tragedy and others like it have left those in the mental health field, along with the rest of the nation, wondering why the tragedy happened — and how to prevent the next mass shooting. Some states, including Maryland, have responded by tightening gun-control laws and augmenting programs to help the mentally ill.


But Maryland also has decided to focus specifically on psychosis.

Founded using a $1.2 million state appropriation approved this year, the Center for Excellence on Early Intervention for Serious Mental Illness has a goal of identifying psychosis in a fresh way: by taking notice in the earliest stages and providing support before symptoms spiral out of control.

"Tragedies like shootings raise public consciousness about anything we might be able to do to prevent those kinds of horrors from happening again," said Gloria Reeves, a child and adolescent psychiatrist at the University of Maryland Medical Center in Baltimore and a leader in the program. "And we can demonstrate plenty of information about how it helps to identify kids at early stages. I'm confident we'll be able to show that this works."

The center has no brick-and-mortar headquarters yet, as organizers work to establish a collaborative foundation. That entails beefing up three existing mental-health programs at the University of Maryland School of Medicine, adding a fourth that includes researchers and clinicians at the University of Maryland, Baltimore County, and coordinating all four under a single organizational umbrella.

Organizers say the result is a multidisciplinary service that can identify young people at high risk for developing psychosis — the center works with people between 12 and 22, a prime age for first onset — and provides a "continuum of care" for anyone who needs it.

Reeves and her colleagues say they're working to ensure patients can live normal lives by short-circuiting the possibility of a deeper psychosis that could intensify if left untreated.

Psychosis is a condition that usually is a symptom of a psychiatric illness, such as schizophrenia or, less often, dementia or bipolar disorder.

Patients experiencing psychosis typically hear or see things that aren't there or harbor false, often paranoid beliefs — for instance, that actors on television are sending them coded messages or that loved ones are spying on them to "steal" their thoughts.


Sufferers often withdraw socially, abandon activities they once enjoyed and have trouble functioning normally.

The majority of people afflicted with psychoses never commit violent acts, let alone the kinds of horrific, high-profile crimes that have left wakes of destruction at Virginia Tech, in Newtown, Conn., and elsewhere across the country in recent years, said Robert W. Buchanan, a professor of psychiatry at the University of Maryland medical school who is directing the center.

Only a few mass shooters are known to have experienced psychotic episodes — notably Jared Lee Loughner, the college dropout who fatally shot six people in Tucson in January 2011. James Holmes, who also had such episodes, has been charged in the deadly 2012 shooting at a Colorado movie theater.

But psychosis does leave sufferers at higher-than-normal risk for abusing alcohol and drugs, experiencing trauma and engaging in self-destructive and violent behaviors, Buchanan said, a fact that gives the subject "a critically important public-health aspect."

"Mass shootings are so rare it's hard to draw definitive conclusions about causes, but the research shows that the earlier we intervene in the progression [of psychosis], the better the long-term outcome," Reeves said. "We're putting our resources together on the side of prevention."

Because the easiest time to recognize psychosis is after it has erupted into view, the tendency has been to offer medical or psychotherapeutic treatment only after it has disrupted or even ruined lives.


A growing body of research over the past two decades, however, has shown patients are much more responsive to treatment if they're diagnosed early, and there are early warning signs that suggest when a person is at risk for developing psychosis.

"If there's a theme here, it's that an ounce of prevention is worth a pound of medicine," said Jason Schiffman, a UMBC psychologist and a member of the new center's staff.

Researchers at the University of Maryland School of Medicine have long been working to find new ways of dealing with psychosis and related afflictions. The Center for the School of Mental Health, established in the mid-1990s, studies and aims to improve mental health services in schools.

The First Episode Clinic within the medical school's Maryland Psychiatric Research Center treats those who have had their first psychotic episodes during the previous two years. In addition, university researchers began working four years ago on a nationwide project funded by the National Institutes of Health to explore the idea that it's best to treat schizophrenia soon after it first appears.

Buchanan was already trying to bring those initiatives into a unified program — he had submitted a proposal to the University of Maryland Medical System — when a disturbed teenager marched into the Sandy Hook Elementary School late last year and killed 26 people, 20 of them children.

No one knows whether the shooter, Adam Lanza, was psychotic — he'd been diagnosed with another disorder and committed suicide at the scene — but the event shocked Americans and inspired calls for action. In Maryland, Gov. Martin O'Malley proposed gun-control measures that have since become law. But he was also interested in exploring the mental health side of the problem.


That was when Buchanan got a call from Brian Hepburn, director of the Maryland Mental Hygiene Administration under the state health department.

"He said, 'Do you guys have any suggestions about what we can do?'" Buchanan recalls. "Well, I had one."

His idea: establish the integrated center and be sure it focused not on one disease, such as schizophrenia, but on psychosis, a symptom common to several diseases.

The Maryland General Assembly voted to approve O'Malley's request for funding, and the center was born.

The $1.2 million will be used to enhance existing programs and support two treatment clinics, one in Baltimore, the other in Catonsville. The center's most novel aspect, however, might be its fourth element, the Clinical High-Risk Program, an initiative Reeves and Schiffman are rolling out together.

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Research has shown those who eventually develop psychosis have often exhibited early warning signs, clues that give family members, teachers, health-care providers and others a chance to intervene early, if only they know what to look for.


Those symptoms often resemble the ones psychotic patients possess, Schiffman said, though the people affected feel them less strongly

Signs might be such things as people suddenly becoming suspicious of friends' or strangers' motives, feeling hyper-alert to the stimuli around them, or getting a sense that time is passing more quickly or slowly than is actually the case.

Anyone can experience such feelings at times, Reeves said, but if they persist and cause distress, they're worth looking into.

The Clinical High-Risk program will be contacting schools, houses of worship, law enforcement and other communities that come into contact with youth to promote public awareness about such signs, Schiffman said, and clinicians will be available to provide testing and offer treatment options.

Will it be enough to prevent the next Sandy Hook or Navy Yard incident? That, organizers say, is difficult to predict, but they are convinced a focus on prevention can help turn a legacy of heartbreak into healing.