McLean Hospital 115 Mill Street Belmont, MA 02478
Experiencing mania or psychosis, especially for the first time, can be frightening, may feel alienating, and can create disruptions to work, school, and relationships. The experience can be overwhelming for both patients and families. Individuals suffering from mania or psychosis may worry that they will fall behind their peers, will not be able to accomplish their long-term goals, and will never return to the lives they had prior to the onset of their illness.
The initial years following a first episode of psychosis are a critical period for intervention. This is when the greatest impact can be made to change the trajectory of illness and reduce the risk of long-term disability.
Most programs specializing in the treatment of first episode psychosis in the United States focus on schizophrenia. However, many early-psychosis patients do not fit into this diagnostic category and might be turned away from such programs. In addition, diagnostic shifts following a first episode of psychosis—whether due to changes in the illness course or misclassification—are not uncommon. McLean OnTrackTM, therefore, accepts all comers with first episode psychosis, regardless of specific diagnosis.
The name “OnTrack” underscores the program’s focus on functional recovery. Our outpatient program emphasizes hopefulness and shared decision making, with the view that empowering young people to act as primary and active stakeholders in their care will improve their chances for a robust and sustained recovery. Recognizing that the disease course is dynamic, treatment plans are formulated around the evolving needs of each patient, incorporating best practices for first episode psychosis.
Because patients in the OnTrack program have different needs, the combination and intensity of services delivered depends on individual circumstances. We offer evidence-based medication treatment, individual and group psychotherapy, community-based care, family support programs, nutritional counseling, and consultations with other specialists as needed. Symptomatic recovery is not strongly correlated with functional recovery and medications for psychosis symptoms may not necessarily enhance functioning, therefore we use the lowest effective doses of medications. Frequency of outpatient visits vary from patient to patient, but typically sessions are weekly, decreasing over time as individuals learn skills to better manage symptoms on their own. Patients continue to participate in the program for as long as is appropriate.
To engage young people in the process of creating meaning in their lives, we use multiple therapeutic approaches, including less-structured activities, such as nature walks, expressive art therapies, and self-narrative psychotherapy, as well as structured psychotherapies, such as cognitive behavioral therapy, personal therapy, individual resiliency training, and interpersonal and social rhythm therapy. Although many of these psychotherapies were originally designed for patients with schizophrenia, we adapt many of these treatments to address varying needs along the full spectrum of psychosis.
Our staff is composed of a multidisciplinary group of board-certified psychiatrists and psychologists, licensed clinical social workers, registered nurses, and expressive therapists. This highly trained and experienced team works to build trusting and collaborative relationships with patients and family members, in a caring and supportive environment, in order to achieve the best possible results. Our goal is to work with each patient to prevent further psychotic episodes, restore a person’s functioning, and help individuals and families regain their sense of control. In addition, we help reduce the stigma that is often associated with mental illness.
A community-based social worker assists with activities such as applying for jobs or navigating meetings with school administrators and, for individuals with difficulty participating in traditional outpatient settings, can also meet with patients and families in their homes or at school. We also support caregivers and incorporate them as an essential part of the treatment team, providing guidance, support, and education, both individually and in a group setting.
“OnTrack helps me feel like I’m not alone. The staff were warm and supportive during a difficult time for me and my family.”– Former patient
We believe that treatment in the OnTrack program, even if limited in duration, can lead to substantial gains in the process of recovery. In the months leading up to the completion of program treatment, our clinicians work closely with participants to find appropriate care in the community and to help patients transition to the next phase of their lives so that they can accomplish their long-term goals.
McLean OnTrack , a part of McLean’s Psychotic Disorders Division, is located in the Admissions Building on the Belmont campus. The building and the program feature comfortable settings and amenities that contribute to recovery.