Perspectives of young adults diagnosed with early psychosis using coordinated specialty care in Texas on substance use and substance use interventions.

AIM: Despite known prevalence of substance use (SU) among young people experiencing early psychosis and increasing evidence for the relationship between certain substances (e.g., cannabis) and psychosis, there are no specialized interventions developed for effectively addressing substance use among young people participating in coordinated early psychosis services. This study elicited the perspectives of young people with early psychosis participating in Coordinated Specialty Care (CSC) programs about their substance use, including their motivations and concerns around their use, and their ideas on how to best support young people who are interested in reducing or quitting substance use. METHODS: We recruited young adults (ages 18 to 30) from CSC programs across Texas through flyers sent to program staff inviting young persons willing to talk about substance use to engage in a 60-90 min person-centered, semi-structured, audio-recorded Zoom interview. RESULTS: A total of 22 young adults were recruited and 18 completed an interview. Participants described mixed positive and negative responses to substance use, and while many understood the importance of discontinuing substance use, many expressed ambivalence related to social, contextual, mental and physical factors that motivated them to keep using. Participants desired practical substance use information, opportunities to explore their substance use ambivalence in supportive relationships, positive peer communities to support healthy choices, help engage, with work, school, and hobbies, and strategies for addressing psychological and physical pain that did not include substance use. CONCLUSION: Study findings illuminate what motivates young people with early psychosis to initiate, continue, or cut back on substance use, and ideas for CSC practices for exploring substances and helping young people to reduce substance use.

Lessons in "Slow" Engagement From Staff and Administrators at a Prebooking Jail Diversion Program.

Objective: In this study, the authors elicited the perspectives of criminal justice and mental health stakeholders about a prebooking jail diversion program, the Judge Ed Emmett Mental Health Diversion Center, serving primarily individuals experiencing chronic homelessness and diagnosed as having a serious mental illness. Methods: The authors analyzed semistructured interviews with 19 participants and observational fieldnotes from 60 hours of ethnographic fieldwork, conducted from January to July 2020 and including five administrative-level meetings. They used qualitative coding to develop themes. Administrative data were also reviewed. Results: Engagement of clients in the program was a major theme. Barriers to engagement included clients' fear of police involvement and strict rules around smoking. Facilitators to engagement included "slow" engagement, or gradual, gentle microengagements over time and across multiple visits, ideally with peer counselors. Conclusions: To promote client use of services at this critical point of care, jail diversion programs might consider ongoing negotiations with clients to balance expectations between the criminal justice and mental health systems of care by using "slow" client engagement, limiting police involvement, and adopting trauma-informed and harm-reduction approaches.