For people living with psychosis there are surprisingly few services in the mental health industry that focus on emotion regulation, according to Maggie Mullen, licensed clinical social worker at the Kaiser Permanente Richmond Medical Center, who uses they/them pronouns.

They set out to change this. Nearly 7 years ago, Mullen piloted a clinical support program for patients with psychosis, which can manifest as delusions, hallucinations, and a struggle with understanding delusion from reality. The program has resulted in positive patient outcomes, including contributing to the Clinical Case Management program’s low hospitalization readmission rate at the Richmond Medical Center.

“It’s focused on skill building and education,” Mullen said. “It teaches people what emotions are, how they function and serve your life, and it gives patients strategies on how to better manage them.”

Drawing on skills from dialectical behavioral therapy, or DBT, the 6-month program teaches patients how to be more mindful, manage stress without acting on urges such as drug use or self-harm, and improve their relationships with others.

“The program and book aim to help people stay out of the hospital and in the community building meaningful lives.”

Groups of about 10 to 15 patients, referred to the program by their mental health provider in psychiatry, meet weekly for a 1-hour session, now held virtually. The program is broken into 4 modules — mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.

A skill or concept is introduced at the beginning of every session, such as how to reduce emotional vulnerability or ways to identify emotions. Patients then work together on how to apply those skills to everyday life.

Positive patient outcomes

One patient with multiple mental health disorders, including psychosis, post-traumatic stress disorder, and attention deficit hyperactive disorder, had such success with the program that he is now enrolled in his second round, something not uncommon among participants, according to Mullen.

“We’ve seen a reduction in self-harm and drug use in this patient with no incidents in the past 6 months, which is really incredible,” Mullen said. “He gained a better ability to control his emotions and communicate with his family, and is able to express his feelings rather than act out.”

Mullen also said several patients have reported improved communication skills, emotional regulation, and the ability to increase pleasurable emotions.  

Democratizing mental health skills

Mullen is so passionate about this work that they wanted to make the information available to people with psychosis anywhere at any time. Their book, “The Dialectical Behavior Therapy Skills Workbook for Psychosis — Manage Your Emotions, Reduce Symptoms, and Get Back to Your Life,” published in February, is a self-help workbook that includes education, worksheets, and guided activities that help readers stay grounded in reality.

Mullen has led employee trainings on DBT-informed strategies throughout Kaiser Permanente Northern California and for the University of California Los Angeles Public Mental Health Partnership, the Ali Forney Center in New York, and the New Roads Behavioral Health Treatment Center in Utah.

“For me, the best part is helping close the equity gap among people with psychosis, including formerly incarcerated individuals or those who have been institutionalized, over medicated, or given poor treatment,” Mullen said. “The program and book aim to help people stay out of the hospital and in the community building meaningful lives.”

Learn more about mental health care at Kaiser Permanente. Read about another mental health support group helping Black members at Kaiser Permanente Richmond Medical Center.

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