Invisible, then inescapably visible: Napa SOAR program treats psychosis with help from those who lived it

In 2017, Marissa LeCount's mind was an overwhelming place to be.

The Sonoma County native was living with her boyfriend in Terra Linda, driving between Mills College, deep in East Oakland, and her part-time sales job at Sunrise Furniture in San Rafael.

She was 28 years old, and she wanted kids, a husband and a career.

Her boyfriend had encouraged her to go back to school. The couple would smoke weed together and muse about plans to open a weed and tea café. Voters the year before had passed a bill legalizing recreational marijuana in California, so LeCount started taking business classes. Meanwhile, another ballot result, the election of Donald Trump to the presidency, filled her with dread.

It was a lot.

LeCount wasn't much of a partier and spent most weekends at home, catching up on rest.

But one February evening, she attended a friend's birthday celebration. She drank, smoked weed and let herself get a little looser than normal.

"I did karaoke seriously for the first time," she said. "I sang 'Bobby McGee' by Janis Joplin, and I was really committed."

The next day, she attended her boyfriend's company party at the Chabot Space and Science Center. Toward the end of the evening, the lights of the planetarium dimmed and starry projections illuminated the room to the sound of Pink Floyd's "Dark Side of The Moon."

"Listening to the whole album, and letting my mind go with it, felt incredible," she said.

When she got home, she didn't feel ready to go to sleep, so she didn't. Instead, she laid awake in bed and texted every friend she could think of. She expressed how much she loved them and shared random thoughts that felt profound to her in the moment.

"All these inputs were swirling around, and I couldn't stop it," she said. "I couldn't get to a restful place."

She barely slept all week, and during that time, no thought was a bad thought.

On Tuesday, she wandered barefoot around a rock formation on the Mills College campus and felt a sacred connection.

On Wednesday, she quit her job and proposed to her boyfriend by leaving clues throughout their house that led him to find her down on one knee, holding a Ring Pop.

On Saturday, she went to brunch with her new fiancé in Fairfax. By that point she was convinced she was a polyglot and spoke to the server in what she thought was Spanish, reinforcing her gibberish with nonsensical sign language. Her fiancé recognized that something was wrong. He ushered her out of the restaurant and drove her to a Kaiser hospital in San Rafael.

Inside the emergency room, LeCount lost control of her mind and began writhing on the floor. EMTs transported her to the Santa Clara Behavioral Health Center later in the day. In the ambulance, she rambled about wolves and noted a feeling of God's presence.

She fought with the hospital staff as they escorted her to her room, and howled at the moon along the way. Then, before LeCount could process what was going on, hospital staff gave her a shot and her mind shut off for the first time in a week.

It's not uncommon for symptoms of psychosis to simmer invisibly until the moment they become inescapably visible. In LeCount's case, her bipolar disorder managed to pass for a mood shift for several days before it boiled over into a psychotic episode.

"Once you're in it, you're in it," she said. "It's kind of like you're in a dream, an awakened dream, but you don't realize it. And the normal social inhibitions that you have and, like, things that hold you back from doing things aren't there."

No one knows for sure how many people in Napa County experience psychosis each year. But one Napa program working to detect early signs of psychotic disorders says patient referrals have been up since the end of 2020, the first year of the COVID-19 pandemic.

The program is called SOAR, short for Supportive Outreach and Access to Resources, and aims to catch early signs of bipolar disorder, schizophrenia and other conditions that can cause psychosis in people ages 12 to 30.

Two years into the pandemic, patient referrals to SOAR more than doubled, from 13 in 2020 to 30 in 2021. SOAR received 23 referrals in 2022 and 18 referrals in 2023.

While psychotic disorders are often related to an individual's genetics, a variety of factors that increased for many people during the pandemic — stress, trauma, isolation, substance use — can bring on symptoms and even psychotic episodes.

"If you were estranged from your friends and peer connection, if you (were) isolating in a home that maybe is an unsafe home, then that can certainly trigger more symptoms for people," said Sarada Oglesby, SOAR's clinical director.

Oglesby said she could not draw a direct line between the conditions of the pandemic and the spike in referrals to SOAR. Still, Kerry Ahearn, CEO of Aldea Children and Family Services, which runs SOAR in Napa, Solano, Sonoma and Marin counties, said the increase in referrals is a good thing.

"If you intervene, then the outcomes for these people are fantastic," Ahearn said. "But if you don't intervene early, as we see, there's a lot of people with substance use disorders, homelessness, in jail, that sort of thing."

Researchers at UC Davis studying early psychosis across California have estimated that in Napa County, about 56 people between the ages of 10 and 39 will experience a first episode of psychosis each year. Most of SOAR's clients are in their late teens or early 20s.

"Stressors are quite high when you're transitioning out of high school or maybe starting college, moving away from home, thinking about becoming independent," Oglesby said. "It's historically kind of a high-stress time."

She said that early symptoms can be difficult to articulate. Instead, an individual might withdraw from friends and family, or start skipping school or work.

"Often, the person themselves will express, sometimes after the fact, that it was just a really confusing time, and they didn't really know what was happening or what was going on," Oglesby said.

Part of Oglesby's work is to train schools, public health agencies and nonprofits to recognize early signs of psychosis. For example, she encourages teachers and mental health workers to pay close attention to young people experiencing mood swings, or reporting that they see shadows in their peripheral vision or hear mumbling when no one is in the room.

The clinical criteria to receive services from the SOAR program include experiencing a first psychotic episode within the past five years, mild psychotic symptoms, and a family history of psychotic disorders with an observable inability to deal with stress.

Still, Oglesby said, it's not always that clear-cut.

"It's complex," she said. "It's never black and white, it's always kind of complicated and has to do with the context."

'They didn't understand psychosis' One summer night in 1990 around 2 a.m., police pulled over 18-year-old Brandon Staglin for reckless driving. He had been weaving in and out of traffic on the freeway and police suspected that he was drunk or high.

But Staglin passed his breathalyzer test. What police didn't know was that he had been driving with his eyes shut. Later, he said he had been trying to find a part of himself he felt he had lost.

Police took Staglin to a station in Martinez, kept him in jail overnight and gave him a bus pass to get home the next morning.

"They didn't treat me very well," Staglin said. "They didn't understand psychosis."

Staglin had experienced his first psychotic episode, which had begun the night before at his parents' home in Lafayette. He was back from his freshman year at Dartmouth College and his parents were away on vacation.

The night before he was arrested, he had tried to sleep but was troubled by an overwhelming sense of anxiety and self-loathing that seemed to come on in an instant.

"The floodgates opened and this vortex world of dread was present," Staglin said. "The rest of that night I couldn't sleep and I couldn't feel like myself. My experienced reality was wrong."

Over the next few days, Staglin wandered around Lafayette and Walnut Creek, feeling lost. He was terrified by his inability to sleep and by the third night was convinced he was going to die. He called an ambulance for himself, though when he got to the hospital he was unable to describe to a nurse what was wrong with him.

"She said, 'Well, you got to tell me why you're here. What's your health complaint?'" Staglin recalled. "I couldn't explain it to her in a way that she would understand."

A high school friend picked Staglin up from the hospital to take care of him and convinced him to go to a psychiatric hospital.

"I didn't want to go," Staglin said. "I thought of it as the end of the line, over the cuckoo's nest and never coming back."

To avoid being forcibly committed by doctors, Staglin agreed to voluntarily commit himself.

"A doctor helped give me medication, but not until after I had panicked, acted up, been placed in an isolation room and injected forcibly," Staglin said. "I was just so scared."

The experience inspired Staglin and his family to start One Mind, an organization that funds research, works with scientists and policymakers on mental health issues, and counters stigmas associated with mental health disorders.

"Personally, I can't think of any morally acceptable way to live my life other than to give back to the community and society that helped me recover from this horrible illness," said Staglin, now 52. "We understand how vast the problem is in our world and want to do something about it."

Early intervention was a major focus of One Mind from the start. Staglin remembers that, while at Dartmouth before his first episode, he had developed early symptoms of schizophrenia, which included hearing voices.

"(They were) saying things to me, infantilizing things like, 'Baby Brandon, you're a mixed-up kid,'" Staglin recalled. "It was really concerning to hear these things. Do I need to heed this? Is there something wrong with me?"

By 2008, Staglin had moved to Napa County and had learned of the work of Dr. Tara Niendam, a clinical psychologist at UC Davis who was helping to develop a clinic in Sacramento focused on psychosis and early intervention. The Staglins wanted to implement something similar in Napa.

In 2014, One Mind and Niendam joined with Aldea and secured the funding to start SOAR.

Niendam, who is now the executive director of UC Davis' early psychosis programs, said that Napa officials were initially uncertain that the program would serve enough people locally to justify funding it.

"There's often a misconception that it is rare, that it's not that many people ... why should we spend money on this?" Niendam said.

The view that psychotic disorders were rare was, at the time, common across the state. But according to a review of early psychosis programs, led by Niendam in 2023, over 20,000 people between the ages of 10 and 34 are estimated to experience a first psychotic episode in California each year.

"We just hold so much stigma around this disorder, that a lot of people are confused at first, why we're sort of asking for this special funding for a special program," Niendam said.

In a 2019 paper, "The Rise of Early Psychosis Care in California: An Overview of Community and University-Based Services," Niendam found that there was little coordination among California programs aimed at catching and treating early signs of psychosis. At that time, 41% of California's counties had developed early psychosis programs and 21% were in the process of developing them.

"What we learned from that evaluation was that everyone was doing something different," Niendam said. "There was very little harmony."

Since then, she's created a database to track outcomes for more than 600 people in California who have experienced symptoms of psychosis and are receiving care from SOAR or similar programs.

"It's a huge number, considering we had no data on anybody, anywhere," Niendam said.

The power of peers LeCount never married her fiancé. They split about a year after her first psychotic episode. After a stint working in the weed industry, she decided it wasn't right for her. Since 2017, she has been hospitalized three more times. With the help of medication, she hasn't experienced an episode since 2020.

Today, LeCount works as a peer counselor for SOAR. She's 36 now, and says she's learned a lot about taking care of her mental health. She meditates, moderates her drinking and smoking, and journals to check in with herself. Because her work is so intimately tied to her experience, she sometimes has trouble with the clinical criteria used to understand and describe her and her peers.

"It's very hard for me, being on this side of the couch, to follow that and not push up against it and feel like it's all a spectrum," she said. "It's going to look different for everybody."

Still, the job has changed her life. She says the benefits of peer support work go both ways, and that working with people who understand what psychosis feels like, and how it can affect one's life, has been a part of her own healing.

"It's just that moment of shared experience," LeCount said. "Being able to connect on that and feel you're not alone in that, that you're not crazy, that's really powerful."

You can reach Riley Palmer at 707-256-2212 or .

Government and Education Reporter