Is Treatment for Psychosis Possible in a Public Mental Health System?

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Length: 24 minutes

Kristina Muenzenmaier, MD; Mara Conan, PhD; Toshiko Kobayashi, LCAT, ATR-BC; Faye Margolis, PhD; Ekaterini Spei, PsyD

The panel developed out of collaboration of members of the trauma committee at a major state psychiatric hospital in New York City.  The trauma committee is multi-disciplinary, multi-ethnic and includes both inpatient and outpatient staff.  Committee members believe that the psychotic symptomatology of many of the patients we treat has often developed as a result of the traumatic circumstances they have faced throughout their lives.

The need to cope with stress and trauma often leads to fragmentation on multiple levels. On the individual level, trauma can lead to disrupted identity development, disconnection of thoughts, feelings and behavior.  On the interpersonal level, secure attachment may be disrupted and the relationships with others are often experienced as confusing and threatening. 

Re-traumatization often occurs when current circumstances are experienced as reenactments of the past. The external environment may be viewed as chaotic and fragmented.  This fragmented world is often reenacted in the systems with which trauma survivors engage.

The main goal of this panel is to discuss the presenters’ efforts to promote a multi-layered, trauma-sensitive, and integrated approach to healing within a state facility with limited resources.  They discuss a variety of therapeutic modalities that aim at treating individuals diagnosed with serious and persistent mental illness: cognitive remediation, music and art therapy, individual and group verbal therapy.  The panel explores and discusses the collaborative aspects of the work rather than providing a detailed description of each treatment modality.  They present a case vignette to illustrate their integrative approach.

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