MST-Psychiatric, an Adaptation of Multisystemic Therapy

Posted by Melisa Rowland, MD

May 30, 2017 8:15:00 AM

To wrap up Mental Health Awareness Month, we are highlighting a story from an MST-Psychiatric case

Jenna Smith was worried. Something was wrong with her son. She had suspected a problem for several years, but now there was no denying it—Rodney was ill. It was his mind. Jenna first noticed symptoms three years earlier, around Rodney’s 14th birthday. At that time, he was having trouble sleeping and would wander the halls of their apartment late at night, talking to himself. He stopped cleaning his room and often neglected his personal hygiene. 

At first, Jenna chalked this up to stress. The family had recently moved. Rodney changed schools and was hanging out with a new group of kids. The mother could see these new friends were wild, unsupervised trouble. On top of which, Jenna was pretty certain they smoked dope. Rodney’s father, Daniel, was convinced that his son’s odd behaviors were caused by drug use.

The parents searched for a way to help their son. Over the ensuing three years, the family sought help from his school, mental-health centers, substance-abuse counselors and emergency rooms. They went to the ER eight times. Five of those visits landed Rodney in a psychiatric hospital due to violent outbursts and paranoid behavior. Each time he was placed, the doctors and staff diagnosed him with substance-induced psychosis and sent him home after clearing his system of drugs. Unfortunately, Rodney would soon relapse.

During one of Rodney’s hospital stays, two of his friends were arrested for burglary. That was the tipping point for Jenna and Daniel. Exhausted and desperate for help, they reached out to the New York City Administration for Children’s Services (ACS) Family Assessment Program Services (FAP). They asked their FAP intake-assessment worker to place their son out of the home under court order. The Smiths felt that they had hit rock bottom as parents. They didn’t want to give up on their son, but were afraid he might get arrested or harm someone. Filing a legal petition with ACS and the family court was pretty much a last-ditch effort.

Youth with mental illness more likely to land in juvenile justice system

It is not uncommon for youth like Rodney, with mental illness, to become entangled in the justice system.

There is evidence1 that youth with mental health problems are more likely to get arrested than peers of the same age without emotional disorders. Looking at the research, it is estimated that between 50 and 70 percent of youthful offenders have diagnosable behavioral-health disorders2 compared to 9 to 13 percent in the general population.

Despite the need for mental health services in the juvenile justice population, data from multiple sources suggests that juveniles are not receiving adequate or appropriate mental health and/or substance abuse treatment services when placed in any type of juvenile facility.4 

Indeed, shunting youth into the justice system likely exacerbates their underlying mental health problems. In these facilities, youth are often exposed to violence, as well as physical, emotional and sexual abuse from residents and staff. Such exposure and victimization is not likely to improve their mental well-being. Add to that, incarceration isolates the young people from families and decreases the chances of good parental relationships. And once a youth is placed, the odds of recidivism are high; creating a revolving door of harmful intervention that makes it less likely mental health, substance use and antisocial symptoms will be alleviated.5 

No placement until evidence-based intervention tried

If the Smith family had lived in many other parts of the U.S., trying to get help for their son through the judicial system would likely have backfired and entangled him in judicial placements. This family, however, was fortunate as an array of evidence-based treatment options were available to help their son. New York City’s ACS has been providing research proven, family-based clinical interventions and services for youth experiencing serious behavioral, emotional and substance use disorders since its 2006 Juvenile Justice Initiative. These services are ecological in nature and designed to keep the youth in the community and the family together whenever possible. As a result, when Rodney’s family went to the ACS office to petition for his removal, they were told that they had to first try an evidence-based intervention. Rodney was initially placed on a MST team specializing in substance abuse treatments, yet due to the severity of his mental health problems he was quickly re-assigned to a MST-Psychiatric team.

MST-Psychiatric is an adaptation of MST specifically designed to serve families with youth exhibiting serious mental health, substance abuse and behavioral problems. The effectiveness of MST-Psychiatric has been demonstrated in two published randomized clinical trials and several unpublished randomized trials and quasi-experimental studies. Research supports the therapeutic effectiveness of this intervention in reducing youth internalizing and externalizing behaviors, improving family functioning and increasing the time youth are able to live at home.

The Smith family benefited greatly from the integration of a child and adolescent psychiatrist into the MST-Psychiatric team and the additional training provided to therapists and supervisors to assist with the assessment and treatment of mental health problems in youth and their caregivers. In Rodney's case, the team gathered evidence that helped the psychiatrist rule out substance-induced psychosis and helped the family engage with interventions targeting a primary thought disorder. With proper treatment, Rodney's symptom's stabilized. He stopped talking to himself and slept better. The team also worked with the family to cut off Rodney's access to drugs, reduce his association with anti-social friends and increase his pro-social activities to reduce his substance use. Rodney’s school was integrally involved with the team in both assessing and treating Rodney. Rodney’s school placement is now stabilized and he has made big gains at school behaviorally, and small gains academically. Stay tuned for future blogs about MST-Psychiatric. 

Works Cited

1 Vander Stoep et al., 2000; Evans and Vander Stoep, 1997
2 Collins et al, 2010; Fazel, Doll and Langstom, 2008; Teplin et al., 2002; Kazdin, 2000
3 Wasserman, Ko and McReynolds, 2004
4 Wasserman, Ko and McReynolds, 2004; Schubert and Mulvey, 2014
5 Henggeler, 2016


Topics: Mental Health