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The Psychosis Identification and Early Referral (PIER) Model

Image Source: The Psychoanalytic Institute of the Contemporary Freudian Society

By Taylor Smith

Adolescents and college-age men and women are statistically at a high risk of experiencing the onset of a psychotic episode, particularly if they are genetically predisposed to mental illness.

Psychosis is medically defined as the presence of at least one of the following: hallucinations, delusions, disorganized speech, and disorganized behavior, which may refer to mania, states of agitation, catatonia and/or inappropriate emotional responses.

Interestingly, characteristics of psychosis can often be induced under extreme circumstances. For example, the recreational use of hallucinogenic drugs, heavy drinking, sustained stress, lack of sleep, poor nutrition, and general anxiety can, over time, make anyone more vulnerable to mental illness.

The PIER model is aimed at early identification and intervention when it comes to the onset of psychosis and psychotic episodes. According to its website, “The PIER Model treats the earliest symptoms of mental illness. It was developed on a foundation of ongoing research that indicates that early mental illness can be markedly altered or reversed by earlier treatment. Through a combination of family psychoeducation, supported education and employment, and pharmacologic treatment, the PIER Model has a powerful effect in reducing the symptoms that place a young person at risk for the onset and severe disabilities of mental illness.” (

The program was developed by Dr. William R. McFarlane, a psychiatrist in Portland, Maine, who believed that an impending psychotic break could be identified. Much like early detection efforts in the treatment of cancer or heart disease, McFarlane told the New York Times, “When you develop severe mental illness, you are driving off a cliff. Imagine if you could stop a process that’s already underway?”

While an estimated 1 in 20 young people live with the challenges of mental illness, college resources and psychiatric services are often inadequate. In contrast, PIER advocates argue that even severe mental illness disorders, like schizophrenia, need not undermine a student’s college education and/or prevent them from completing their degree.

The Structured Interview for the Psychosis-Risk Syndromes (SIPS) is the assessment tool used by PIER in the screening of at-risk youth. During the assessment, a trained SIPS interviewer asks questions about the onset, frequency, duration, and intensity of symptoms to determine “severity and function.” As cited on its website, the mother of a recent PIER Model client was noted as saying, “Following confidential assessment, with her permission, we developed an intervention plan that helped her stay in school.”

To learn more about the PIER team and services, visit

If a PIER facilitator is not available in your area, students, families, and education professionals are advised to reach out to the NAMI HelpLine at 800.950.6264 or the Samhsa Treatment Locator at 800.662.4357.

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