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To most people, Katie looked fine. She was often tired and maybe a little sad, but this hardly qualified as unusual for a 16-year old girl trying to deal with adolescence.

Katie continued to pass her school assignments in on time, and her parents heard good things at open houses and parent/teacher conferences.

But Katie thought that she might be losing her mind. She was terribly afraid and her internal world was in turmoil. She was changing – only it took a while for people to notice. The warning signs were well hidden.

Someone like Katie, who always set high standards for herself, doesn’t draw attention if they “slip” a little. But then Katie stopped washing her hair, lost interest in her appearance and began to hand in muddled school assignments late – or not at all. Few people that Katie interacted with could see all the pieces or recognize that these slight changes in her behavior formed a disturbing pattern. It took a while for all of these changes to attract attention.

But Katie was lucky. One of her teachers did notice and asked to speak with her at the end of class one day. At first, Katie was uncomfortable talking, but eventually she opened up. Katie described the disturbing thoughts she had, often in class, and how difficult it was to shake them. One time, she imagined seeing something traumatic happen to her classmates and sometimes she thought she saw a boy watching her through the hall door window… but there was never a boy there. Every once in a while, especially in the cafeteria, she thought she heard someone calling her name or seemed to overhear other students talking about her. But when she asked her close friends, they denied it.

She really didn’t hear what was being said in class. And sometimes when the teacher wrote on the board, Katie fought the urge to scream and run out of the room. In biology class, she often asked to leave the room because the noise of the fish tank filter pump was so disturbing to her. The overhead lights in class often seemed too bright so she began to keep her head down.

The teacher who approached Katie quickly realized that she was very upset and very anxious. She discovered that Katie’s friends thought she was having a rough time, but were not sure why. To them, Katie had a nice home, a nice boyfriend, and a part-time job she enjoyed.

Katie and the teacher talked with the school social worker. While the teacher could not say for certain what was affecting Katie, she knew that some of what she was experiencing went beyond depression – in particular her experiences of the bright lights, loud noises, and the assault of jumbled thoughts.

Both the teacher and the social worker had been taught to recognize the early indicators of a severe mental illness in adolescents and young adults by the community outreach team from the Portland Identification and Early Referral (PIER) Program. Informing and educating general medical practitioners, mental health professionals and the wider community is a unique and critical feature of a PIER Model Program. In Katie’s case, knowing about the early signs of psychosis led directly to her recovery.

Katie’s referral resulted in a confidential assessment and, with her permission, an intervention plan that included her family. The multi-disciplinary PIER team’s Support Education Specialist was able to help Katie stay in school. The team delivered ongoing family guidance and support, provided comprehensive and supportive education about symptoms and behaviors, and utilized an effective combination of psychosocial treatments with appropriate medication and monitoring of symptoms.

Today, Katie’s symptoms are markedly reduced and she has developed effective coping skills for those occasional symptoms that do occur. Her grades are back up and she is once again exhibiting the passion for life that was the hallmark of her real personality. Because of PIER, the school staff, and her health providers, Katie has the opportunity to live a healthy, rewarding, and productive life.