Dr. Michelle R. Munson to Test “Meta-Intervention” to Help Young Adults with SMI Engage in Their Mental Health Care

Awarded $713,000 Federal Grant for Randomized Trial

Young adults with serious mental illness often discontinue their treatment before even getting started. Research has shown a myriad of reasons for this public-health concern, including beliefs that treatment is not helpful, beliefs that engaging in mental health care will make them targets of discrimination, lack of trust in providers, and costs, to name a few.

Spurred by both personal and professional experiences with the extremely difficult challenge of helping individuals, and loved ones, accept that there is a need for professional help, Silver School Associate Professor Michelle R. Munson has made it her mission to help the mental health system better respond to those in their late teens and 20s whose mental health challenges, if left untreated, impede their ability to form relationships, hold jobs, live independently, and function well in society.

Dr. Munson, who is Director of the Silver School's Youth and Young Adult Mental Health Group, said intervening with young adults is particularly important because it can be “trajectory setting” for people with mental health challenges. “When young people leave their caregivers’ homes,” she said, “they have a new opportunity to be the drivers in their mental health care decisions.” At the same time, they are often transitioning from the child mental health system to a new system that serves adults. A lot of young adults don’t ‘see themselves’ in their new programs, where the other clients may be much older and have different life experiences. As a result, Dr. Munson said, many young adults with mental health challenges decide they do not need treatment anymore. “As is often the case with young people, they may self-medicate with cannabis, alcohol or other substances, or they may find themselves at a loss for what to do. This can lead to escalating numbers of young adults coming to emergency rooms in a psychiatric crisis.”

To begin to address the problem, a research team led by Dr. Munson is launching a new study to test a novel engagement intervention designed with young adult partners aimed at helping them develop a positive mental health narrative, feel less discrimination, experience more hope and ultimately decide to continue a mental health treatment plan that works for them. The National Institute of Mental Health (NIMH) has awarded Dr. Munson and her team a three-year, $713,000 grant to support a developmental trial of the intervention, called “Just Do You,” in New York City adult mental health programs serving predominantly minority young adults living in stressed and low-resourced communities.

The trial, which will assess the intervention’s impact on young adults’ health behavior and outcomes, will launch on November 1, 2017 at ICL’s Personalized Recovery Oriented Services (PROS) program in Brooklyn and the Jewish Board of Family and Children’s Services’ PROS program in the South Bronx. It will ultimately expand to up to three more PROS programs and enroll a total of 200 participants (100 in the experimental arm and 100 in the control arm), who reside in poor, under-resourced communities.

Dr. Munson describes Just Do You as a “meta-intervention” because it is “an intervention about interventions” designed to increase young adults’ health literacy about the programs that can help them and increase their engagement and level of investment in needed treatment. Delivered after intake in two 90-minute group modules, it is based on formative research she conducted, along with others, over the past decade examining the underlying causes of treatment dropout, and an original theory her research team developed on what can be done about it.

“It is all about orienting young adults to adult programs in ways that capture their attention and help them see the possibilities for recovery,” said Dr. Munson. As a result, facets of the intervention include the use of online videos and segments from podcasts in which well-known sports, music and entertainment figures discuss their battles with mental health challenges. Allowing clients to hear from contemporaries they likely admire helps to normalize their condition and it can provide hope for them in their own lives. It also helps put their treatment into perspective, and assists them in understanding the rationale and goals of mental health care. Other activities include writing song lyrics and drawing images that enable participants to process emotions and thoughts about what it means to take medicines, go to appointments, and live with a mental health diagnosis. It addresses questions and barriers to continued treatment at the same time the young adults build attendance routines and therapeutic relationships with their mental health care providers.

Another important aspect of the intervention is that it is led by both a social worker and a peer support specialist known as a “Recovery Role Model,” who has had lived experiences similar to that of the participants. According to Dr. Munson, “One of the things that came up repeatedly in our interviews with young adults before we designed the intervention is that they want to learn from somebody who has ‘been there.’”

In addition to co-facilitating the group exercises, the Recovery Role Models share their own journeys around how they moved toward trusting their mental health counselors and about the value of showing up at appointments to work on their recovery. They also talk about what their lives look like today, which may include having their own apartments, working or going to school, and having girlfriends or boyfriends. “These are basic things that many young people with mental health conditions think are impossible,” said Dr. Munson. “A lot of our work is based in Albert Bandura’s theory of observational learning. That is, if I observe you having a full life after being diagnosed with schizophrenia then maybe I might be more hopeful that I can too.’”

Dr. Munson said the name for the intervention came from her previous research. “We kept hearing the phrase in our interviews. When participants talked about people judging them because of their psychiatric diagnosis – a real problem that is alive and well – individuals said a version of ‘I just tell them, you go ahead and do you and I’m going to do me.’ Before we had even designed the intervention, I realized I should call it ‘Just Do You.’”

“The gestalt of ‘Just Do You’ is that you can still be who you are even after you learn that you have a mental health condition,” Dr. Munson added. “You are not your diagnosis. But in order to reach your goals and live a life in recovery, you have to find a mental health care plan that works for you. So that you can keep doing you.”