First Episode Psychosis Program Spotlight
The Early FEP Program at UNM

By Imani Thompson
TA Assistant, The MayaTech Corporation


The Substance Abuse and Mental Health Administration (SAMHSA) defines psychosis as a condition that makes it difficult for an individual to differentiate what is real and what is not, leading to a disruption in their thoughts and perceptions. Individuals may perceive things that others do not or hold strong beliefs about things that are not true, such as delusions (false beliefs) and hallucinations (seeing or hearing things that others do not see or hear). They may also experience other symptoms of psychosis, which include incoherent speech, memory problems, trouble thinking clearly or concentrating, disturbed thoughts or perceptions, difficulty understanding what is real, poor executive functioning (the ability to use information to make decisions), and behavior that is inappropriate for the situation.1 The early onset of psychotic symptoms (up to five years after initial onset) is referred to as first episode psychosis (FEP). SAMHSA has demonstrated its commitment to support individuals experiencing psychosis, including FEP, through dedicated funding, program, and resources. These programs and other resources have enabled many states across the nation to implement treatment programs and facilities to assist in the treatment, education, and awareness and support SAMHSA’s commitment to improving the lives of individuals experiencing psychosis and FEP.1

In this article, the second of our series highlighting SAMHSA FEP programs, we are excited to spotlight the work of the Early FEP Program at the University of New Mexico (UNM). The Early FEP Program provides behavioral health care and culturally based care treatments to adolescents, young adults, and other individuals ages 15-30 who are struggling with worrisome changes in thoughts, feelings, or behaviors and are experiencing psychosis. Through a series of innovative treatments, the UNM Early FEP Program helps these individuals achieve their goals for school, work, and relationships. The program is dedicated to understanding, treating, and raising awareness about psychosis, in addition to taking care of symptoms that may lead to the onset of a serious mental health disorder.

Excerpts from an interview with UNM’s Early FEP Program staff members: Dawn Halperin, MA LPCC CPRP, director and Bess Friedman, MSc LMSW, program specialist.

Can you tell us about the work that’s being done through UNM to support individuals who have experienced FEP?

  • The Early FEP Program at UNM provides clinical services to individuals in New Mexico ages 15-30 who have experienced a first lifetime episode of psychosis within the past 12 months. Clinical services are provided by a multidisciplinary team of specialists and follow a general coordinated specialty care model that emphasizes recovery, resiliency, and shared decision making. Services are both in person and via telehealth depending on the clients' needs.
  • In addition, the Early FEP Program provides community psychoeducation and resources through outreach to schools, community organizations, etc., in an effort to identify symptoms and find rapid supports. Finally, the Early FEP Program offers clinical rotations/preceptorship for students across disciplines as well as consultation, training, and resources to providers across New Mexico to improve care for individuals experiencing psychosis.

How accessible are UNM’s Early FEP Program resources for the student populations versus the community at large?

  • The Early FEP Program is equally, if not more, accessible to New Mexico’s students. Our program connects with high school and college counseling offices to help identify psychosis and transfer care rapidly when appropriate. In addition, our services are located on UNM’s campus – making services easily accessible to UNM students (both graduate and undergraduate). We often recommend our clients join groups such as Students with Psychosis for further supports and community building, and we have hosted study groups at UNM libraries for our college or graduate-level clients seeking a space to work, familiarize themselves with the campus, and build local community. Our team has extensive experience working with schools in New Mexico and in other states to advocate for our clients to receive required supports and complete their educational goals.

Can you share one of UNM’s biggest program accomplishments regarding FEP?

  • Despite the challenges of providing services during the COVID-19 pandemic, the Early FEP Program has grown significantly in the past two years and increased fidelity to the CSC model. This has resulted in improved enrollment among eligible referrals, increased engagement, and reduced wait times to begin services (see attached report). Mental health services are limited in New Mexico – with wait times of up to 6 months for outpatient psychiatry. Finding psychosocial supports and services is also a challenge and the individuals seeking help are left to navigate this independently. We are proud to not only offer timely services, but holistic care from a cohesive team.

What resources are provided by UNM’s Early FEP Program specifically for minority populations (e.g., Black, Indigenous, and People of Color and LGBTQ individuals)?

  • The Early FEP Program supports all clients in expressing their identity. For this reason, services are made available in multiple formats and spaces to increase accessibility in regards to client needs, comfort, and preferences. Members on our clinical team have specialized expertise in working with immigrant, transgender, and Hispanic populations and clients are given the opportunity to work with these clinicians as desired. However, Early FEP Program clinicians recognize the importance of each individual’s personal story and journey and continues to learn and incorporate different modalities of intervention based on client needs and feedback. We ensure that all clinicians, regardless of expertise or specialization, have the training and capacity to self-reflect and communicate openly about differences.

What steps has your program taken to meet the needs of culturally diverse populations?

  • The Early FEP Program provides individualized services that are not model-specific and emphasize shared decision making to allow for flexibility based on each client’s needs. We take into consideration language needs of both client and family, utilizing interpreters. We use the clients preferred language around symptoms and experience. We formulize client experiences around cultural identity and provide a space for reflection around cultural dissonance and how this may impact mental health symptoms. We collaborate with client’s identified natural supports, including spiritual leaders and traditional healers. We utilize program evaluation data to identify service gaps (ensuring our clients are reflective of the unique demographic profile of New Mexico). We continue to work with leaders/providers and the community of specific cultures in order to improve pathways to care/decrease disparities in accessing care and increase program cultural sensitivity and proficiency.

What have been some of your programs best practices or lessons learned? Successes or things that might have been challenges? Foreseen or unforeseen?

  • The reliance on telehealth practices during the COVID-19 pandemic created the opportunity to reassess standard practice. One important lesson we learned is that telehealth offers engagement and continuity of care opportunities that were not being utilized. Prior, telehealth was utilized for clients living at a substantial distance from the clinic. It is now offered to all clients, and we have seen an unexpected improvement in attendance and engagement in services. Examples of those positively affected by this additional option includes individuals struggling with executive function or other symptoms that may make getting to the office incredibly challenging, individuals who feel ill but who still want to keep their appointment with their clinician, and individuals apprehensive to go to a mental health center for appointments at onset of engagement due to stigma or previous negative associations with mental health treatment and facilities. Incorporating different modes of technology into the Early FEP Program’s standard practice overall has allowed for our team to introduce services at the pace and space that clients need to successfully build rapport and feel safe with their providers. However, this shift in practice is not without challenges. For example, we are still learning how best to support clients to shift from telehealth to attending in person appointments when appropriate.

How can someone who is experiencing FEP access services at UNM?

  • Call 1-888-663-2759 (1-888-NM-EARLY) and leave a voicemail with your name and phone number. Our team will return your call within 2 business days.

What advice would you give to current MFP fellows and alumni considering working with FEP programs?

  • Your experience, perspective, and interest are needed in FEP work! In New Mexico and across the United States, FEP programs lack diversity in the workforce. Increasing the presence of minority providers in FEP programs opens space and discussion for clients and families and for fellow providers as well. We feel honored to walk with our clients on this part of their journey and we encourage you to join us in this fulfilling work.

For more information on FEP, FEP treatment, and the UNM Early FEP Program, use the following resources :

References:

  1. First Episode Psychosis and Co-occurring Substance Use Disorders Evidence-Based Resource Guide Series. Substance Abuse and Mental Health Administration (SAMHSA). (2020). Accessed February 16, 2022.
    https://store.samhsa.gov/sites/default/files/d7/priv/pep19-pl-guide-3_0.pdf