Moving cross-country for a better clinic

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I am 24, non-binary, and I moved from rural Wyoming to Boston eighteen months ago for the express purpose of becoming a patient at a coordinated specialty care (CSC) clinic for early psychosis. I want to write about what it took to make that move, because moving cross-country for psychiatric care is something a lot of people in rural areas need to consider and almost no one writes about.

Why I needed to move

I had my first episode in my last year of college, when I was 22. I was at a small state university about three hours from the town where I had grown up. I came home for winter break and never went back. The county where I grew up had one psychiatrist for the entire population. He saw me once a month for fifteen-minute medication management visits. He prescribed haloperidol because that was what he prescribed. He had no specific training in early psychosis. There was no therapy available. There was no coordinated specialty care team. The nearest CSC clinic — which I learned about later from a Reddit thread — was in Denver, six hours away.

The literature on early intervention is not subtle. Coordinated specialty care for first-episode psychosis is associated with better symptom outcomes, better quality of life, and better engagement with treatment than usual care. The RAISE program from NIMH documented this in detail. I knew, within a few months of being home, that the care I was receiving was inadequate to the medical event I had had. I also knew that there was nothing in my county or my state that resembled what I needed.

The decision to move

The conversation that decided it was with my mother. She had been the one driving me to the appointments. She is a nurse and she had been quietly reading about early psychosis since my hospitalization. One evening in February she sat down across from me and said: "We need to look at this honestly. The care here is not what you need. We can either learn to live with that or we can move."

We made a list of cities where well-established CSC programs existed. Some were on the list because the programs were public; some because of academic affiliations. We narrowed by cost of living, by transit, by whether either of us had any family or friends in the area, and by what kind of work I might be able to find within the limits of my current functioning. Boston ended up at the top because of the density of programs and because my mother had a cousin in Cambridge who was willing to host us for the first two months.

The planning year

1. Insurance research. The single biggest variable in cross-state moves for mental health care is insurance. Some clinics take Medicaid; some do not. State Medicaid does not transfer. I would need to enroll in Massachusetts Medicaid (MassHealth) on arrival. We confirmed in advance that the clinic I was targeting accepted MassHealth.
2. Records request. I requested copies of all of my psychiatric records from my hospitalization and from my outpatient visits. These took weeks to arrive. Showing up to a new clinic with your records in hand makes the intake faster and the medication continuity safer.
3. Direct contact with the new clinic. I called the intake line of the Boston clinic six months before the move. The intake coordinator was honest about waitlists, about what they could and could not do, and about what they would need from me to start the intake process the day I arrived in Massachusetts. We scheduled a tentative intake appointment for two weeks after my expected arrival.
4. Bridging the medication gap. My existing psychiatrist agreed to write a 90-day supply of my current medication so that I would not run out during the transition. We did not change anything during the move.
5. Housing. My mother and I rented a small two-bedroom apartment in a Boston neighbourhood within transit distance of the clinic. We signed a one-year lease. We did not over-commit financially.
6. Income. I had been receiving SSI in Wyoming. SSI transfers between states but the federal portion may be supplemented differently by state — the Social Security Administration's website was clear on this. I confirmed in advance that I would not lose benefits during the move.
7. Mental health crisis plan. We made a written plan for what we would do if I had a wobble during the transition — which hospital we would go to in Boston, how we would get there, who I would call. The plan was on the fridge by the third day in the new apartment.

The move itself

We drove. Five days, with my mother, a U-Haul, and my dog. We took it slow. We stopped early each night. I took my medication at the same time each day regardless of the time zone change. I slept in the back of the car for part of the third day because the noise and the road were exhausting. The trip was not glamorous. It was a medical operation.

We arrived in Boston on a Sunday. I had my intake at the clinic on the Friday after.

What the new clinic gave me

The intake took three hours. I saw a psychiatrist, a therapist, and a case manager in the same visit. They reviewed my records. They asked about my goals. They explained the program — weekly therapy, monthly psychiatry, supported employment if I wanted it, family education for my mother, peer support if I wanted it.

Within the first three months on the program:

• My medication was adjusted off haloperidol and onto aripiprazole, which fit me much better. The transition was managed slowly and carefully by a psychiatrist who specialised in first-episode care.
• I started weekly CBT for psychosis with a therapist trained specifically in CBTp. The voices that I had been quietly managing began to quiet meaningfully for the first time.
• My mother attended four sessions of family education. She had been carrying the role of caregiver largely alone in Wyoming, and the education changed how we communicated.
• I started a part-time job through the supported employment program, fifteen hours a week at a bookstore.

Eighteen months in, I am stable in a way I had not been in Wyoming, in a city I have come to love, in an apartment that is mine. My mother is going back to Wyoming next month. We have always known the move was for me, and that her staying for two years was a finite gift. I will be okay alone.

What I would say to someone considering this

• Map what you are missing carefully. Not every move is needed. Some can be addressed with telepsychiatry or by travelling for periodic consultations.
• Insurance is the gating factor. Confirm in writing that the new clinic accepts the insurance you will have after the move.
• Bring your records. Do not show up empty-handed.
• Arrange a bridging supply of medication. Do not change medications during the move.
• Move with at least one person who can absorb a bad week if it comes. A solo cross-country move during early psychosis is risky.
• Sign a short lease at first. You may discover the city does not fit and the clinic does. Or vice versa.
• Use SAMHSA's Find Treatment tool and NIMH's RAISE program directory to identify CSC programs by state.

For more, see coordinated specialty care and early intervention services for schizophrenia.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.