Exploring psychosis, stigma, inclusion and well-being

Each May, the U.S. recognizes Mental Health Awareness Month, established 75 years ago to highlight the importance of this essential issue in Americans’ lives. It’s also a time to recognize the resilience of people who live with mental health conditions and honor all those who stand by them – a group that includes both family and friends, and the dedicated mental health care professionals providing services to improve their well-being.

Psychologist Jason Schiffman is deeply committed to assisting others. The professor of psychological science heads a research team that has published over 200 scientific articles and acquired over $15 million in funding for their work on psychosis. He also trains and consults for clinics across the county on best practices for supporting people on the psychosis continuum. As the director of UCI’s Clinical Psychology Program, he helps guide cohorts of graduate students who are similarly compelled to provide mental health care for others.

What is psychosis and what do we know about it? Why do mental health challenges like psychosis still have a pervasive stigma and how can our community come together to change that? How is UC Irvine playing its part in providing mental health services with its new Psychological Services Center, and how can community members access care? What are some simple steps we can all take to protect and improve our own well-being? Schiffman answers these questions and more in this episode of the UCI Podcast.

The music for this episode, titled “A Quiet Thought,” was provided by Wayne Jones via the audio library in YouTube Studio.

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UCI’s Psychological Services Center currently offers individual therapy for adults over the age of 18 who reside in California. Community members interested in inquiring about low-cost, evidence-based assessment and therapy for depression, anxiety, trauma and stressor-related disorders, and other mental health concerns can call (949) 824-5411 or email psychology-clinic@uci.edu.

TRANSCRIPT

The UCI Podcast/Cara Capuano:

From the University of California Irvine, I’m Cara Capuano. Thank you for listening to The UCI Podcast.

May is Mental Health Awareness Month, established in 1949 to increase awareness of the importance of mental health and wellness in Americans’ lives, to honor the resilience of those who live with mental health conditions, and to show gratitude for the professionals and loved ones standing by them.

Mental Health Awareness Month also provides an opportunity to combat stigma and promote education about mental health resources – two driving forces behind the career of Jason Schiffman, our guest today on the UCI Podcast.

Schiffman is a professor of psychological science in UC Irvine’s School of Social Ecology, and the director of UCI’s Clinical Psychology Program. He has also established and run two community-serving public mental health care clinics focusing on preventing psychosis and is co-founder of the Orange County nonprofit “Thrive Together OC,” whose mission is improving outcomes for youth at clinically high risk for psychosis.

Welcome to the UCI Podcast, Professor Schiffman – thank you for taking the time to chat with us.

Jason Schiffman:

Thank you so much. So happy to be here, and happy Mental Health Awareness Month.

Capuano:

Absolutely. Let’s start with your work. As I already mentioned, your primary research focus is on psychosis, which is characterized by the National Institute of Mental Health as a collection of symptoms that affect the mind where there has been some loss of contact with reality. So, during an episode of psychosis, a person’s thoughts and perceptions are disrupted, and they may have difficulty recognizing what is real and what is not. Psychotic illnesses, such as schizophrenia, affect only about 3% of people worldwide – and, as such, they’re often the least understood and the most stigmatized. What drew you to this specific line of study?

Schiffman:

Thank you for that question – and it’s an important question because I think it motivates me and many members of my team and the community that tries to help better understand people with some of these challenges. You know, the challenges that you outlined can be really taxing for individuals and the mystery behind them is something that I think we can – together – begin to pull the curtains back from – or unveil – such that we might be able to get insights into the ability to alter people’s trajectories in really positive ways.

Our work is all about the prevention of mental health concerns related to psychosis because we think that if we can find folks early in their course, work with them, partner with them, we can help them live a life of their choosing, live a life in the community, and live a life of contentment and happiness. And all these aspirations are things that drew me to this field – being able to make a difference within this population, a very vulnerable population. Some of our most vulnerable brothers, sisters and siblings are struggling from mental health concerns related to psychosis and so it’s important to reach out and to help and support them.

I will say that 3% doesn’t seem like a lot in the grand scheme of things, but it really equates to a lot of people. In fact, there’s about a hundred thousand adolescents and young adults developing psychosis in the United States every year.

Psychosis and disorders like schizophrenia have tremendous burdens associated with them. One appalling statistic is that people with a diagnosis of schizophrenia have a shortened life expectancy, relative to the general population, by 20 years. That’s to say that people with schizophrenia are more likely to die 20 years earlier than people without.

There are a lot of contributors to this terrible statistic. One of them is an increased risk of death by suicide. So, awareness of death by suicide, awareness of suicidality, awareness of the challenges that confront people with psychosis is important. And it’s not just shortened life expectancy, but a disconnection from others, a disconnection from society, a disconnection from gainful employment or meaning making in life. And it’s not just the individual with the label or the diagnosis, but also family members and loved ones as well. So, for all these reasons and more, I think this is an important pursuit, and it’s my professional passion as a result.

Capuano:

I know that you train and consult for clinics across the country on best practices for supporting people that are on the psychosis continuum. You mentioned youth. When does the onset of psychosis generally occur in people?

Schiffman:

Sort of the modal age of onset for psychosis is somewhere roughly between, let’s say 17/18 to like 22 to 25 or so. It’s a little on the earlier side for men – or adolescent boys – and a little bit on the later side for women, but adolescence is a real key time here. So, we’re thinking about young people that are transitioning in terms of their meaningful relationships, their relationships with their family members, their role in society, their educational and occupational paths all coming into focus. And if a person’s struggling with mental health challenges related to psychosis on top of all these typically stressful developmental considerations, then the outlook can be pretty grim unless there’s some partnership and some opportunities for people to come together.

Capuano:

Early identification and recognizing ways that you can create partnerships and come together and help, what does that look like?

Schiffman:

You know, that’s really the motivating factor for much of what we do. So, there’s a concept in the field of psychosis – it’s called the “duration of untreated psychosis.” And it’s kind of is what it sounds like, but it’s this window of time between when a person would meet threshold or criteria for psychosis, and when they get the effective help and care that they need. The window of time between these two points in the United States is on average somewhere around two years. So that is to say that people are living with a diagnosable mental health concern related to psychosis for two years before they get adequate care.

The longer this period of time is, the worse outcomes are. So, the more need for services, the more disconnection with reality and society, more occupational impairment, educational impairment – all sorts of negative outcomes are associated with longer duration of untreated psychosis.

If we can minimize this duration – or in some cases maybe even find folks before they develop psychosis – then we might be able to alter trajectories in really positive ways. So, I was referring to this concept of “an ounce of prevention being worth a pound of cure.” In this case, it’s all about reducing duration of untreated psychosis so that we can minimize that length of time if a person is destined to develop psychosis.

For folks that are destined to develop psychosis, if we can work with them early, we might be able to attenuate the symptoms that they ultimately have, or maybe delay or postpone psychosis from emerging. In some cases, we may also be able to prevent psychosis from ever happening in the first place. And this is something exciting and really worth pursuit.

Capuano:

That’d be amazing.

Schiffman:

In this field, we really feel like we’re on sort of the cutting edge of a revolution. The conversations we’re having right now about prevention of psychosis weren’t things people were talking about when I got into the field 25 years ago but now because of attention to these contextual and clinical factors – and greater awareness of mental health concerns – society is shifting. And we’re thinking about things in preventative ways – ways in which we weren’t dreaming about before. So, I’m excited about the future.

Capuano:

At a time when there’s a lot of pessimism, to hear you say that gives me some hope and some optimism and I appreciate it. There’s so much stigma around mental health conditions. Why does that still exist? The idea that it takes two years to potentially diagnose someone blows my mind.

Schiffman:

Stigma’s a big contributor to that statistic, I’m sure of it. When you think about stigma, there’s maybe like two constructs to grapple with. The first type of stigma is sometimes referred to as “public stigma.” It’s the public’s perception of a condition of this – in this case, psychosis. And this negative stigma with psychosis includes things like people with psychosis are dangerous; people with psychosis are personally responsible for all of their challenges; people with psychosis can’t hold a job or contribute to society; people with psychosis are incapable of making their own decisions.

These larger perceptions can then be used externally to create a public policy that infringes upon the rights and the access to services of people with psychosis. And it can also contribute to how a person that might be grappling with some of these things perceives themselves. And then we call that “internalized stigma,” where they’re internalizing these external factors. And this can lead to things like shame and demoralization and self-blame, disconnection. And even some of those symptoms that we’re talking about, like increased risk for suicidality. All of these things can contribute to a person feeling less inclined to reach out for help and being less likely to receive the services that they deserve, from which they could benefit.

People fear being ostracized, and they may ignore their feelings, deny their symptoms, and hide them or conceal them from others. All of these things as a result of stigma, all of these things resulting in delays in care, longer duration of untreated psychosis and ultimately worse outcomes. If we can reduce stigma as a society, we might be able to make inroads there.

Capuano:

How can community members take steps to help reduce at least the “public stigma” element?

Schiffman:

This is such an important question with like a good answer. One of the things that I am known to preach is that people with psychosis are far more similar than they are different from people without psychosis. And if we think about all of us being connected in some ways, it creates a more inclusive community where people feel more comfortable with their strengths and their vulnerabilities. If you’re more comfortable with both, then you may be more likely to reach out for help. And that reaching out for help can create connections in different ways, not just for the person that needs this assistance, but also for the people which they’re turning to. And that inclusivity, I think, is a real powerful element that we can all strive towards – all of us.

In terms of the literature and the research that sort of pushes the idea of reduction of stigma forward, well, there’s sort of like two parts of a solution. One is education. So, understanding that people with psychosis are far more similar than they are different – or that they’re not all dangerous; that they’re not all unpredictable; that they’re not all grappling with unstable housing. These are some stigmas that are preconceived notions that people have.

But rather, if we think about, like most people with psychosis are far more similar than they are different: they live in the community, they’re connected with others, they have loving families and they love their families in return. They tend not to be any more dangerous than anyone else in the community. In fact, there’s a plethora of risk factors for violence that make a person more violent than psychosis and psychosis is just a modest increase relative to things like past history of aggressive behavior or substance use.

Folks with psychosis oftentimes want to contribute to society and have gainful employment or pursue education and their dreams. We call this this type of concept “recovery.” And we should be thinking about recovery as the expectation and not the exception for people with psychosis. One of the ways in which all of us can facilitate recovery is by believing in one another, by believing in people that have mental health challenges, by looking for their strengths. So, when you come back to this idea the two factor solution for reduction of stigma, one is education and understanding some of these things. And then the other is just interacting with people. You know, we know that if we have a chance to connect with someone, we will find commonalities and we will have these connections, and then that reduces the stigma because we see this person is real.

One of the things that my team and I have done was we created this video where we interview people, young people, on college campuses who are in college – doing just great – but also grappling with mental health concerns related to psychosis. And they share their stories, and they share the things that have helped them recover, which is oftentimes connection with others, the love of a friend and professional mental health care. All these things can lead to a more positive outcome.

And it’s inspiring to see not just their bravery, but its impact on the people that watch the video and people that are watching this video report a greater likelihood or an increased willingness to seek mental health services themselves. So, these folks with psychosis are the inspiration for others. They’re reducing the stigma by having the connection and people in the community, I think can gain from that, but they can also do their own part as well – like some of the things that I was sharing about education and inclusivity and taking the time to care and, for lack of a better word, expressing love and kindness. So, I think that makes all the difference.

Capuano:

It is inspirational that at least we’re at a time point where those conversations are happening, and the changes are being made. So, we’ve talked a lot about your revolutionary research. You’re also the director of UCI’s Clinical Psychology program, which is new to campus, welcoming its first cohort of nine students back in 2021. Can you share a bit, please, about the genesis of that program and its overall goals?

Schiffman: 

I’m so excited about our Ph.D. program. The genesis of this program emerged before my arrival in 2020. For years prior to that, the School of Social Ecology, which is known for bringing science towards solutions to be applicable in their scholarship such that the work that we do in Social Ecology makes the world better, not just in an ivory tower silo. A Ph.D. in clinical psychology is – I can’t think of a better path towards such a goal or mission.

And so, some thoughtful leaders within the School of Social Ecology, including faculty, staff, and administration, decided that they were going to make the long-term investment in the mental health future of our community by creating leaders through this Ph.D. program. I think our students that we attract… I want to say that this is a very competitive program: this past year we received 350 applications for just five admissions. So, our students are the best in the brightest in the country, maybe – dare I say – the world.

There are factors that make them so tremendous. I think they’re brilliant. They’re hardworking. They care about others. But, most importantly, they apply all of these great skills towards making the world a better place. They fully believe that together as a community – through our science and through our compassion, which are not mutually exclusive phenomenon – we can create paths and inroads into some of humanity’s biggest challenges. And so, improving the human condition is something that we all strive towards.

And I want to say this: one of the things that I’m particularly proud of – actually within my program of research around psychosis and with the mission of our clinical psychology program – is that we pursue all of these things with an eye towards equity. And that we understand that there are members of our community who have been marginalized and othered throughout the history of this nation and this world, and some of the work that we do – and the ways in which we point our energy – has particular attention to these factors in ways that I hope will subtly and slowly but persistently make a difference for everyone.

Capuano:

Following a ceremonial ribbon cutting back on February 28th, the School of Social Ecology’s new Psychological Services Center opened to the public and started accepting referrals for individual therapy. The “PSC,” as we call it, sits at the intersection of community members who need access to quality mental health care and this next generation of young mental health professionals that’s being trained through the clinical psychology program. How did that come to be and how’s it going?

Schiffman:

Oh, I am so proud of our clinic right now. The “PSC,” as you described, came to be because of the hard work and dedication of a lot of people. Most notably is our clinic director, Dr. Naomi Tabak, who is probably the best clinic director in the country, and we were fortunate enough to recruit her. But, in partnership with our dean, Dean Jon Gould, and assistant dean, Jennifer dos Santos – along with a host of other colleagues, partners and friends – we were able to create this clinic within the School of Social Ecology right there on campus that is at the nexus of offering the highest quality evidence-based care by some of the most talented, young, aspiring clinical psychology graduate students at an affordable cost. We provide care on a sliding scale that can make therapy accessible to everyone.

If any of your listeners happen to be interested in receiving care, most of our care is done on campus but we also offer teletherapy. So, this could be available to anyone in the state of California. Psychology-clinic@uci.edu – that’s the email – psychology-clinic@uci.edu.

Capuano:

We will put it in the show notes, for sure.

Schiffman:

One of our missions is to create more accessibility for mental health care services. If any one of your listeners has attempted to receive mental health care, they know the challenges and the dearth of the mental health workforce. Now, this is our small way of trying to expand the affordability of care and the accessibility of care as well.

Capuano:

Such an important service. You hold so many roles in your professional life, I’m sure no two days are the same for you, what is holding the majority of your attention right now?

Schiffman:

Right now, I’m very present in my conversation with you. You know, that’s one of the most important things – to be present in the moment. And that can allow us to do more in that moment and then do more in the next moment where we’re present there.

The thing I may love most about my job – and I love my job – is the variety. There’s like so many different things that I have the privilege of doing. Some of the things include, first and foremost, being a teacher. So, I have a lot of different parts of my professional identity, but if someone were to come up to me in the community and say, “Hey, what do you do for a living?” I would say, “I’m a teacher.”

Teaching my classes is inspiring for me because it’s something that I love and it’s something that I learn and grow from. So, I learn far more from my students than they do from me, I’m afraid.

I also enjoy mentoring. So, I work very closely with my graduate students, my postbac students and my undergrad students to push our research forward. You know, this idea that we can find folks on a continuum of psychosis risk and work with them – a lot of research needs to be done together to keep that revolution pushing onward. And so, that’s one of the things that I love doing and working with my team as well as my staff. So, my staff are unbelievably dedicated and competent, and many of them are going on to graduate school as well – and doing things together is part of the thrill of doing anything.

As you mentioned at the beginning, I co-founded a nonprofit. That nonprofit provides mental health evaluations, consultation and a lot of training that I personally do to grapple with stigma, to increase education, to support the mental health workforce in understanding psychosis and psychosis risk so that more people can be sensitized to the idea of duration of untreated psychosis; early referral; reducing the time in which a person has a diagnosable psychotic illness and when they get care; and being part of the revolution more broadly.

I also provide clinical supervision for mostly my students but also therapists in the nonprofit. I do a lot of consulting as well. So, folks from around the country will contact me about their own mental health services for people at risk for psychosis and I teach them what I’ve learned – mostly from family members and community members, and the clients that we serve. I share that throughout the nation.

Within UCI, some of the things that I’m passionate about include creating a more inclusive community. So, I’m the DECADE representative for our department and the DECADE mentor helps students, especially graduate students, create more inclusive communities within our department so that people feel welcome to learn and to grow and to share different and new ideas with one another.

The clinic itself, as you mentioned, is just like a pride and joy of mine and under Naomi and the graduate students’ direction, it doesn’t need much from me at this point, but I try to continue to add a little more wind to the sails. The clinic couldn’t be stronger, so, again, I encourage folks to reach out and be a part of that.

The last thing about my professional life that keeps me busy is that I wanted to mention was that my team and I hold a portfolio of research grants, many funded by the National Institute of Mental Health, and these grants are designed to help us identify risk factors for psychosis risk. They might involve neuroimaging or EEGs and a lot of psychosocial determinants of health as well. We think about factors like discrimination and poverty and other factors that might contribute to the development of psychosis, with this idea being that we can understand these factors and then parlay them into better identification strategies, which can then be further parlayed into intervention services.

Those grants, I think, are a big part of my work, one of them in particular. Several of them are multinational, with all sorts of different folks involved. One in particular though is designed to reduce the risk of suicidality by wrapping folks at risk for psychosis with natural supports. So, it’s not just me as a therapist that’s connecting with them, but we’re bringing in the people that care about them in the community to be a part of the treatment team. And I think that that goes a long way, not just in reducing suicidality, but also in increasing connection and the warmth that they may feel.

The last thing – if I have the microphone – that keeps my attention I guess the most is the love of my kids. Jacob and Chloe are two wonderful human beings and as it pertains to mental health and mental health awareness, they both do their part. One of the things that I was most proud of as, as they were growing up, was that I would organize flash mobs. I did this for eight years in Maryland and both of my kids are dancers, and they would choreograph the dance and they would come to my campus back then and lead these flash mobs.

The idea behind the flash mobs was to raise awareness for mental health concerns. We would have a panel afterwards where community members would talk about their mental health challenges, but it was my kids that kicked it off. I’m happy to say that Chloe – who is the wellness ambassador of her school, and a peer mentor and on a committee to reduce suicidality in her high school – she came to UCI this spring and led our first UCI mental health awareness flash mob. So, those are the things that I think about and that fill me with joy and passion.

Capuano:

That is so fantastic. And yes, your love, your passion, your gift toward improving the mental health and wellness of others is very palpable. I mean, we can hear the smile in your voice as you talk about it. In the spirit of Mental Health Awareness Month, what are three tips maybe that you can share with the audience about different small ways they can guard or even improve their own mental health?

Schiffman:

This is a great question and, you know, I think about this for myself and for my kids and my friends and the folks that I work with, my students… and some of them probably have heard some of these recommendations. But first one: I think sleep is incredibly important. You know, no amount of therapy or mental health services or whatever can replace a good night’s sleep. So, keep sleep as your foundation.

I also think – related – is being active is really important, too. So, like doing things – exercise is great as well. So, behavioral activation is broadly defined, but it could be exercise, it could be being with other people. Connecting in some way, and movement in some way, I think is really healthy too.

This last one is a little bit broader. Broadly defined: find pursuits that you’re passionate about. You know, we’ve all heard the advice, “Follow your passion.” I think that’s good advice, but it does need to be unpacked a bit, you know? Because we don’t always know what our passions are. We don’t always feel passion. Passion can change. It’s a dynamic process.

So, think about trying to do things where you find yourself satisfying these three conditions. The conditions include doing things that you like that are fun for you, that you enjoy. Doing things that you’re good at, where you have some skill or some efficacy, where people are like, “Hey, great job! High five! You know, you nailed that.” And then lastly for me, the third condition – or the third factor – is doing things that matter, that make a difference, that connect you to the world and that help the world out in some way that is meaningful to you and perhaps to others as well. And if you can find yourself in that intersection, I think I would contend that you’ll be leading a life of contentment, of satisfaction, of abundance. And that is, I think, a good place to be.

So, I would say, think about following your passion. That might include, like things that you would do for yourself. But it might also include self-care in terms of how you care about others and the reciprocity of that.

So, follow your passions, but understand that that takes some work. And maybe thinking about doing things that you like, that you’re good at and that matter – make a difference – could help you in that pursuit.

Capuano:

And they say that taking care of ourselves must be done for us to be able to help others. So that all makes perfect sense.

Schiffman:

Yeah. It’s a virtuous cycle.

Capuano:

It absolutely is. Thank you so much for joining us today, Professor Schiffman. I’ve really enjoyed our conversation.

Schiffman:

Me as well. Thank you so much. May I just end with just an expression of gratitude? I mean, this conversation has been really important and meaningful for me. And you just brought out, you know, some of my passion. And so, you know, when we talk about creating better mental well-being, you have helped facilitate that with me today. So, I’m really grateful. Thank you.

Capuano:

I couldn’t agree more. I feel the exact same – thank you. I’m Cara Capuano. Thank you all for listening to our conversation. For the latest UCI News, please visit news.uci.edu. The UCI Podcast is a production of Strategic Communications and Public Affairs at the University of California, Irvine. Please subscribe wherever you listen to podcasts.