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Harmony: Team-Based Treatment for Individuals with Early Episode Psychosis

Harmony is one of three mental health block grant funded programs in the State of Iowa. It is based upon the NAVIGATE treatment model. NAVIGATE is a comprehensive program designed to provide early and effective treatment to individuals who have experienced the first episode of psychosis. It was developed with support from the National Institute of Mental Health’s ‘Recovery After an Initial Schizophrenia Episode’ (RA1SE) project.


Psychosis is characterized as disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t. These disruptions are often experienced as seeing, hearing, and believing things that aren’t real or having strange, persistent thoughts, behaviors, and emotions. While everyone’s experience is different, most people say psychosis is frightening and confusing.

Psychosis is a symptom, not an illness, and it is more common than you may think. In the U.S., approximately 100,000 young people experience psychosis each year. As many as three in 100 people will have an episode at some point in their lives.


First-Episode Psychosis refers to the first time someone experiences psychotic symptoms. People experiencing the first episode of psychosis may not understand what is happening. The symptoms can be disturbing and completely unfamiliar, leaving the person confused and distressed. It is usually unclear during a first episode what will happen with symptoms over the long run and if the early problem will develop into something more long-term. A psychotic episode typically occurs in three phases. The length of each phase varies from person to person.








Early warning signs before psychosis

Early psychosis or FEP rarely comes suddenly. Usually, a person has gradual, non-specific changes in thoughts and perceptions, but doesn’t understand what’s going on. Early warning signs can be difficult to distinguish from typical teen or young adult behavior. While such signs should not be cause for alarm, they may indicate the need to get an assessment from a doctor.


Encouraging people to seek help for early psychosis is important. Families are often the first to see early signs of psychosis and the first to address the issue of seeking treatment. However, a person’s willingness to accept help is often complicated by delusions, fears, stigma, and feeling unsettled. In this case, families can find the situation extremely difficult, but there are engagement strategies to help encourage a person to seek help.

It’s important to get help quickly since early treatment provides the best hope of recovery by slowing, stopping, and possibly reversing the effects of psychosis.

Signs of early or first-episode psychosis

Determining exactly when the first episode of psychosis begins can be hard, but these signs and symptoms strongly indicate an episode of psychosis:

  • A worrisome drop in grades or job performance

  • Suspiciousness or uneasiness with others

  • Hearing, seeing, tasting, or believing things that others don’t

  • Persistent, unusual thoughts or beliefs that can’t be set aside regardless of what others believe

  • Strong and inappropriate emotions or no emotions at all

  • Withdrawing from family or friends

  • A sudden decline in self-care

  • Trouble thinking clearly or concentrating

Such warning signs often point to a person’s deteriorating health, and a physical and neurological evaluation can help find the problem. A mental health professional performing a psychological evaluation can determine if a mental health condition is involved and discuss the next steps. If the psychosis is a symptom of a mental health condition, early action helps to keep lives on track.


Psychosis includes a range of symptoms but typically involves one of these two major experiences:


Hallucinations are seeing, hearing, or feeling things that aren’t there, such as the following:

  • Hearing voices (auditory hallucinations)

  • Strange sensations or unexplainable feelings

  • Seeing glimpses of objects or people that are not there or distortions

Delusions are strong beliefs that are not consistent with the person’s culture, are unlikely to be true, and may seem irrational to others, such as the following:

  • Believing external forces are controlling thoughts, feelings, and behaviors

  • Believing that trivial remarks, events, or objects have personal meaning or significance

  • Thinking you have special powers, are on a special mission, or even that you are God.

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