By Michele Munz

By Michele Munz

St. Louis Post-Dispatch

ST. LOUIS

When the Places for People outreach team found Chandra Thirdkill, she was about 40 years old and had been homeless for two years. Her struggles, however, began as a teen. Everyone looked at her like she was ugly, she thought. No one liked her. She constantly got into fights.

Thirdkill dropped out of high school, turned to alcohol and drugs, and was in and out of jail as the fights grew to involve dishes, knives and bricks. Shooting and injuring her then-husband landed her in prison for three years.

That’s when she was finally diagnosed with schizophrenia. Her cell mate told officers she was talking to people who weren’t there.

After Thirdkill was released, she struggled to stay on her medications, was suicidal, had a child taken into state custody and had several hospital stays.

Gary Morse, associate executive director for Places for People, said that’s when social service organizations often find those suffering with severe mental illness – after decades of missed education, severed family connections, lost jobs and stints in and out of prison or hospitals.

“So much of our system is developed around people with long-term critical mental illness,” Morse said. “Our system’s resources are devoted to that far end, and not very much to the beginning.”

Schizophrenia – which makes it difficult to distinguish what is real from what is imaginary – is one of the most devastating of mental disorders. Experts say only about 15 percent of people with schizophrenia recover, meaning they are able to work, live on their own and have friends. About 10 percent will die by suicide.

The predominant treatment has been chronic disease management. The damage has been done, so doctors just try to manage the symptoms over time.

But results from a study published this month show that early and comprehensive intervention can alter the course of the disease. Just as importantly, it shows clinics how to implement and pay for it.

The study is an example of what is needed to more successfully treat and even prevent mental illness in America, said Robert Heinssen, director of the division of services in intervention research at the National Institute of Mental Health. “It’s telling us that there is a better way of doing it, and we can do a better way.”

Thirdkill, 47, remembers not being able to understand why she was so mad. “When I would get into a fight,” she said, “I wasn’t happy until I saw someone bleed.”

She’s one of the lucky ones. She now has her own apartment and spends her days attending group therapy classes and volunteering in the kitchen at Places for People, where she has many friends. If she had continued on her path, she said, she knows she’d be dead or in prison.

The increasingly destructive path that mental illness tends to follow is known as the kindling theory, after the small wood that sparks a campfire. Every time a person has a psychotic break, the brain’s chemistry changes, making it more prone to future episodes.

About 10 years ago, countries with government health systems began having success with early intervention. Heinssen and others at the National Institute of Mental Health wondered how the effort could be put into action in the U.S., with its much more complex health system and funding sources.

They didn’t just want a study to determine the most successful treatment, he said. They wanted research showing how providers could adopt the interventions in their clinics with all their barriers and challenges.

The National Academies of Sciences, Engineering and Medicine reported in July that well-researched interventions are not used routinely in clinics or even taught in training programs for mental health providers. The report blamed problems of access to care, insurance coverage and fragmentation of care.

Providers in the U.S. can more easily turn to the use of medications rather than evolving interventions like talk therapy, strategies to handle unhealthy thoughts, educating family members or help with going to school and keeping an apartment.

Outcomes have been dismal: Mental disorders are among the most common causes of disability. The suicide rate remains stagnant. Only half of people treated for depression reach recovery. Adults living with mental illness die an average of 25 years earlier than other Americans, largely due to treatable medical conditions.