Targeting Internalized Stigma in First-Episode Psychosis Services: Treatment Strategies from an Intersectional Perspective

Young people who first meet criteria for a schizophrenia-spectrum disorder are considered by the field to be experiencing first-episode psychosis (FEP). Early intervention for psychosis saves lives, and specialized early intervention programs have proliferated over the past two decades. However, critical gaps in such care related to access, equity, and inclusion are still being addressed. Within this article, we first provide a composite clinical vignette from our clinical and research experiences, followed by background and history on the early-stage psychosis field. We then focus on discussing evidence-based clinical practices in this area and gaps in current services—especially related to targeting intersectional stigma and related stressors in care. Psychosis is among the most stigmatized and misunderstood health conditions in the world and many young people diagnosed with FEP experience internalized (or self-) stigma (i.e., incorporating negative mental illness stereotypes into one’s identity). Internalized stigma can prevent youth from fully engaging in care and has been consistently associated with a host of negative outcomes, including symptom severity, social isolation, suicidality, and functional deficits. Specific assessment and intervention tools are shared and discussed throughout.