RECOVERY AFTER INITIAL SCHIZOPHRENIA EPISODE (RAISE)

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The ¿Recovery After an Initial Schizophrenia Episode¿ (RAISE) initiative seeks to fundamentally change the trajectory and prognosis of schizophrenia through coordinated and aggressive treatment in the earliest stages of illness. The President's New Freedom Commission on Mental Health calls for transformation of the mental health system in the United States, envisioning ¿a future when everyone with a mental illness will recover.¿ Perhaps the greatest challenge to this new vision is schizophrenia, a devastating mental illness that impairs an individual¿s ability to think, feel, and relate in a normal manner. Schizophrenia typically begins in late adolescence or early adulthood, thus derailing the interpersonal, academic, and vocational achievements that prepare a young person for adult roles and responsibilities. Recurrent episodes of psychosis are common, with multiple hospitalizations and gradual worsening of functioning. Once schizophrenia becomes established as a chronic illness, poor outcome is generally the norm. The first episode of psychosis represents a readily identifiable event in the course of schizophrenia, and a unique opportunity for intervention. Given current knowledge of the earliest phases of schizophrenia, the best chance for altering the discouraging prognosis commonly associated with the illness is to intervene aggressively at the first episode of psychosis, before functional abilities are lost. The RAISE initiative will test this hypothesis by supporting the development, refinement, deployment, and testing of an early intervention model for schizophrenia that is relevant to the U.S. mental health system, in the sense that ¿ if found to be effective in real world settings and relatively cost-effective ¿ it could be deployed feasibly at a population level. RAISE will shift the focus of schizophrenia treatment away from managing end stage disease to early and aggressive treatment. The goal here is indicated prevention that pre-empts symptomatic and functional deterioration in the early years of illness. RAISE represents a coordinated effort to design and test an effective intervention for early phase schizophrenia that can be implemented on a wide, i.e., population-level, scale. From the earliest stages of development, this intervention will incorporate necessary features for rapid dissemination, adoption, and implementation in our communities, thus facilitating the transition from research to practice. The ultimate goal is to transform the current paradigm for treating schizophrenia in the United States by engineering rapid adoption and implementation of an effective treatment package on a broad scale. RAISE is a necessary first step in this process and will help to determine whether early identification and intervention programs situated in community-based settings can slow or halt clinical and functional deterioration in schizophrenia.