Why Doesn’t Wealthy Arlington Va. Offer First Episode Program? More Peers & Navigators?

Dissociation from MedPage Today

(3-29-21) A group of parents is asking Arlington County (Va.) Behavioral Health to launch a First Episode Psychosis program that will provide intensive case services to young adults ages 15-30. The parents said Arlington County is the only mental health provider in Northern Virginia that does not offer the program.

Why doesn’t it? After all, this Washington D.C. enclave is the sixth wealthiest county in America?

The parents are asking the county to hire more peer support specialists and navigators who can help connect individuals to eligible services.

In a recent letter to Arlington County Commissioners, one parent wrote:

“My son has been traumatized by the lack of proactive services and repeated hospitalizations.”

Dear Pete,

In January 2020, Arlington Mental Health and Disability Alliance (AMH&DA) teamed with NAMI Northern Virginia to form a young adult advocacy group focused on improving services for young adults with serious mental illness (SMI). During 2020 the group met monthly to share our concerns and struggles. We then reached out to neighboring counties to see how they supported their young adults with SMI and to families in these counties using these services. After one year we presented to Arlington County Behavioral Health (BHD) three areas which we believe are desperately needed:

  1. First Episode Psychosis (FEP) is an evidence-based program that wraps intensive services around young adults ages 15-30. This includes case management, psychotherapy, low-dose medication, supported education and employment, family support and education, and Peers.  Services are individualized, and the treatment team coordinates closely meeting weekly to discuss each client, and family members sre included whenever possible.  This service is offered by all the CSBs in Northern Virginia, but not in Arlington.
  1. Peers are individuals in recovery from mental illness and/or substance abuse who are trained to motivate others in their recovery. Peers are an evidence-based practice shown to be cost-effective and to help reduce symptoms in their clients.  DHS currently has only one peer serving 150 young adult clients.  More are needed to provide the 1-on-1 and group activities as intended, particularly for those who are socially isolated, need motivation for their recovery, or encouragement to voluntarily participate in treatment.
  1. Navigators link individuals experiencing mental illness and/or substance abuse and their families with all available services for which they are eligible. It helps to connect individuals with effective treatment quickly.  This service is offered by Fairfax and Loudoun Counties, among others.

URGENT REQUESTS – For Today, Not Tomorrow

As family members of young adults residing in Arlington who are struggling to recover from SMI, we believe the above requests are urgent. Our young adults need help today, not tomorrow.

An Arlington-based NAMI family support group focused on parents whose young adults have SMI has met monthly for the past 17 years. Parents share stories of their struggles to keep their young adults safe and the difficulty obtaining appropriate services for these young adults. Parents have also shared stories of the negative consequences that occurred when their sons and daughters could not get appropriate services, resulting in substance abuse, arrests, incarcerations, homelessness and permanent disabilities.

We provided stories to the Arlington County Manager, the County Board and Arlington’s Department of Human Services to support our request for a First Episode Psychosis Program, Peers to assist and mentor young adults, and a Navigator. Our stories are not new. For over a decade other families have been advocating for Arlington to make these same improvements for their young adults.

Why Is It Taking So Long?

Why is it taking so long? It feels as if no one cares, or perhaps they don’t understand the significant unmet needs. We want to be able to tell success stories, when we speak to our families, friends, neighbors and county board, and not simply recount more failures.  We are often told there is no staff and no budget for the services we are requesting.  To that we ask that County decision-makers consider this quote from the late, great John Wooden:

So, rather than asking immediately for more resources, we want to hear what more Arlington County BHD “can” do with existing resources, in a way that will be seen and felt directly by our families now.  Arlington County consistently ranks among the top counties in the United States in terms of quality of life, services to its residents, and emphasis on wellness. We’re confident that the same innovative culture that has produced the region’s best schools, transit, and other services can find new and better ways to deliver services for its young adults with serious mental illness.

Yes, First Episode Psychosis programs do cost money, but so does incarceration, repeated substance abuse, and long-term severe illness without recovery.  Are its existing staff who can be deployed in more useful ways to meet the three requests outlined above?  And here is a change the Behavioral Health Division (BHD) of DHS can make now that costs nothing: An attitude change.

This can start today at no cost to anyone.

  1. Compassion – for struggling families. Families and advocates of young adults are not BHD’s enemies we just want help for our struggling young adults.
  2. Understanding and Empathy – for the young adults who may not be able to make the phone call to DHS, track their appointments, manage public transit to get to the DHS building or who may be scared because they do not understand what is happening when the voices, delusions or hallucinations begin.
  3. Assertive engagement – not the “Yes” and “No“ approach presently used. Currently, staff might ask the ill young adult “do you want to go on a walk?” If they respond “no” that is often used as an excuse for not doing anything.  Rather, offer options between two equally positive options.  For example, “would you like to walk to the park or to Starbucks?”  This makes it harder for the young adult to say ”no.”
  4. Ensure young adult services are oriented around “Recovery.” Offer proactive services as opposed to waiting for the young adult to fall into crisis when more intensive services will be needed. These young adults deserve meaningful services that will allow them to live their life with dignity and safety at their highest level of independence.

We appreciate that Arlington County, DHS is hiring more staff, but it is essential that the attitudes outlined above are reflected in their staff and how services are provided.  What can be done now, not sometime in the future? Today there are 24 SMI young adults in the County’s Program of Assertive Community Treatment (PACT), reserved for those with the most serious mental illness, who would be better served by a First Episode Psychosis program.

They deserve a chance at recovery.

Thank you,

Concerned parents.

The Arlington County Manager is Mark Schwartz. Here is his email if you want to forward this blog to him.

The county has five board members. 

Chair Matt deFarranti  email.

Katie Cristol, email

Christian Dorsey, email

Takis P. Karantonis, email

Libby Gravey, email. 


About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.