Coordinated Specialty Care Improves Outcomes, Supports Condition Management For People With Schizophrenia

posted by Darcy Lewis

on May 24, 2017

Schizophrenia, a biological psychiatric brain disorder in which a person loses touch with reality, is devastating and debilitating for the patient, their families, and loved ones. Symptoms like psychosis and paranoia can be extremely disabling. Over time, people with schizophrenia frequently develop additional chronic medical conditions like substance use disorder, diabetes, and heart disease. Their medical care is often received in hospital emergency departments during periods of crisis instead of regular office visits with a medical professional who knows them and can effectively manage their care on an ongoing basis.

Not surprisingly, schizophrenia is one of the most difficult mental illnesses to treat. Until about 10 years ago, doctors who treated people with schizophrenia had limited options. They would design a treatment program including antipsychotic medications, psychotherapy, and community-based support services.

Then in 2008 the National Institute of Mental Health (NIMH) launched a multiyear effort to study whether patients were more likely to get better when their doctors, mental health providers, and family members were part of a comprehensive treatment “team”, making decisions together and helping to coordinate care.

So far, the answer appears to be a resounding yes.


The Recovery After an Initial Schizophrenia Episode (RAISE) Project is a large-scale research initiative that studies and tests coordinated specialty care (CSC) treatments for people experiencing psychosis for the first time.

The NIMH says the RAISE project was designed to study the best ways to intervene after a person begins to experience psychotic symptoms such as hallucinations or delusions. The goal is to change the downward spiral that can result from untreated psychosis, and help return people to a path toward productive, independent lives. “Preventing negative events like dropping out of school, losing the ability to work, and losing contact with friends and family also has the potential to reduce indirect costs to society,” the NIMH website notes.

The two RAISE projects studied the CSC treatment model in a large number of clinics, so results are relevant to many community treatment settings throughout the United States.

What is Coordinated Specialty Care?

CSC is a recovery-oriented treatment program for people with an early diagnosis of psychosis. Research has shown that people with schizophrenia have the best long-term outlook when they receive intensive help immediately upon their first episode of developing psychosis. The goal of a CSC program is to connect a person who had a psychotic episode with a CSC team as soon as possible after the symptoms begin.

In CSC, a team of specialists works with the person with schizophrenia to create a personalized treatment plan. The team makes treatment decisions together based on the patient’s needs and preferences.

According to the National Alliance on Mental Illness, CSC offers the following six key components:

  • Case management – This overall approach helps people develop problem-solving skills, manage medications, and coordinate services.
  • Psychotherapy – Sessions focus on personal resiliency and managing the condition, such as developing coping skills and focusing on self-care and wellness.
  • Medication management –Antipsychotic medicines can work well, but it can take time to find the most effective medication at the most appropriate dose that the patient can adhere to over time.
  • Supported education and employment – A psychotic experience often disrupts major life activities, so it is crucial to support the person’s ability to continue or return to school or work.
  • Family support and education – Psychosis affects many others beyond just the person who experiences it, so it’s important for families to have the knowledge and skills to support treatment and recovery.
  • Peer support – Given the stigma that still unfairly surrounds mental illness, connecting with others who have been through similar experiences can help the patient cope with the diagnosis.

As seen with RAISE and CSC programs, health plans recognize the importance of greater coordination and communication in caring for people with mental health conditions. They continue to collaborate with providers and patients to facilitate access to high-quality, coordinated, evidence-based behavioral health services, and treatment.

Want to learn more? Read our issue brief, “Ensuring Access to Quality Behavioral Health Care.”

" "