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The combination of the family approach and drug support seems to be working well. The National Institute of Mental Health is funding a trial of McFarlane's work, and while he is still writing up his data for publication, his anecdotal results are promising: most of the kids are so far avoiding a first psychotic episode. Even those who have heard voices and nearly dropped out of high school are going to college and getting jobs.
But this approach doesn't come cheap. The kids who are enrolled are bombarded with care: social workers help them at school or work; therapists guide them and their families in individual and group sessions; a psychiatrist or nurse practitioner carefully calibrates their medication based on response rates and side effects.
When members of McFarlane's clinical team gather each day to discuss cases, they know virtually everything about their kids: they know about boyfriends, girlfriends and summer plans. They know the kids' grades in English class, how much pot they smoke, what they did on a recent trip to Disneyland. They know whether Dad just lost his job and if Mom's grandmother killed herself. This is what prevention of mental illness looks like: unwavering, sweeping, complicated. But it works.
One Family at a Time
The Robert Wood Johnson foundation is so impressed with McFarlane's program that it has devoted $15 million to its national expansion. It is the foundation's single largest mental-health initiative. McFarlane's approach costs about $3,500 per patient per year, but compare that with the $150,000 a year to care for a hospitalized schizophrenic or severely bipolar patient.
Still, not all the kids McFarlane sees can be helped. Patti White is a plainspoken 47-year-old Mainer who works for McFarlane as an administrative coordinator. She has a son who began experiencing psychotic symptoms a few years ago, and he might have seemed like a perfect fit for her boss's program. He wasn't; prevention isn't that easy. Instead, White's son Tyler, who turns 20 this month, was too far along in his illness — eventually diagnosed as schizoaffective disorder, a relative of schizophrenia — to benefit from prevention therapy. A social worker on McFarlane's team helped Tyler get into treatment, and he is doing better and holding down a job in food service.
But White has another son, Jacob, who causes her to worry. A few months ago, Jacob, 10, started to withdraw. He was getting paranoid. At school, he started seeing complicated machinations where none existed. And even though White works for one of the world's leading prevention experts, she at first resisted having Jacob take the SIPS test. "If his brother had had diabetes, I wouldn't have thought twice about having Jacob screened for diabetes," she says. "But I just couldn't deal with the idea that another one of my kids would have" — she pauses — "this enormous thing."
Three weeks ago, Jacob took SIPS. The good news: he showed no red flags for psychosis. He does have depressive symptoms and is now taking a low dose of Prozac to help prevent a full-blown depression. But for Jacob — and millions of other Americans with all manner of mental ills — intervention can now come in time.