‘Catastrophic failings’ in schizophrenia care

Important day today: sees the publication of the report by UK Schizophrenia commission The Abandoned Illness

“What we found was a broken and demoralised system that does not deliver the quality of treatment that is needed for people to recover. This is clearly unacceptable in England in the 21st century.”

Here’s a BBC News article on what the report says.

‘Catastrophic failings’ in schizophrenia care

By Jane Dreaper Health correspondent, BBC News

Charity spokesman Paul Jenkins says stigma is a “massive issue” for people with schizophrenia

Care for people with schizophrenia in England is falling “catastrophically short” and requires a major overhaul, an independent inquiry has concluded.

The Schizophrenia Commission, set up by a charity a year ago, said patients spent too long in “demoralised and dysfunctional” hospital wards.

It says the condition costs society almost £12bn a year and money would be better spent on preventing illness.

The government says mental health is one of its high priorities.

A spokesman said: “We are clear that people with mental health problems should be treated with the same high quality and dignified care as anyone else and we expect the NHS to make this happen.”

The commission, which was established by Rethink Mental Illness, says too much is spent on secure care – 19% of the mental health budget in England last year – with many people staying too long in expensive units.

Case study

Dan Lowe, 36, began having psychotic symptoms 16 years ago. He has been admitted to hospital four times, each stay lasting several months.

Dan says he found the stays in hospital sometimes made his paranoia worse.

“A lot of the wards they just put you in front of the telly and calm you down and when you are about to get up or do somthing they just try to persuade you to sit down and watch the telly again.”

He says this “sense of isolation” can make things worse and was the major reason he did not like being in hospital.

Dan is now now taking clozapine, which has helped his recovery. He lives independently in Surrey, with support from a community psychiatric nurse and enjoys taking part in a regular computer course.

Among the 42 recommendations, the report calls for a better use of “recovery houses” in the community, to provide an alternative to hospital admission.

The average cost of a night in a mental health in-patient bed is £321 – meaning a typical admission of 38 days costs more than £12,000.

Schizophrenia is a disorder which affects thinking, feeling and behaviour and symptoms can include delusions, hallucinations such as hearing voices, and loss of interest, energy and emotions.

The commission says early intervention teams, which aim to help people before their hallucinations or delusions become severe, are popular and should be extended. The report claims some teams are being cut or diluted at the moment.

Commission chairman Prof Sir Robin Murray, from King’s College London, said: “If you have psychosis and your mind is disturbed, you need a period of respite and calm.

“But especially in inner cities, you get admitted to something like a madhouse. The nurses are often overwhelmed.”

He said that improving in-patient units had to be a top priority, “to give people a better experience so that if they have another episode then they’re quite willing to have treatment”.

Schizophrenia: Key facts

  • Schizophrenia is a condition which affects thinking, feeling and behaviour and causes people to have abnormal experiences
  • It is caused by a combination of factors. Genes, perhaps slight brain damage at birth or during pregnancy, childhood abuse
  • Street drugs (ecstasy, LSD, amphetamines and crack) seem to trigger it. Stress and family tensions make it worse
  • It is most likely to start between the ages of 15 to 35 and will affect about 1 in every 100 people during their lifetime
  • Many people think that schizophrenia makes people violent – this is the exception, not the rule. People with schizophrenia are more likely to be victims of violence by others
  • Hospital admission is often not needed and many people with schizophrenia live a stable life, work, and have relationships

Source: Royal College of Psychiatrists

“One other thing we can do is to stop spending or wasting so much money on high-security for so long. I think we could save a lot money by getting people rehabilitated quicker, and out of these secure units.”

While there is often perceived to be a link between schizophrenia and violence, this is exceptional and many people with the condition live stable lives.

Sir Robin said: “There’s a preoccupation with risk, and the idea that this is a madman with an axe. But people with schizophrenia are actually more likely to be attacked themselves.

“There’s no other condition where such an emphasis is put on the risk of an effect on other people.”

An economic analysis for the commission highlighted an “exceptionally low” employment rate for people with schizophrenia of 7%, as well as disrupted education – because the illness often develops in young adulthood.

The authors said some of the costs of schizophrenia were unavoidable, but effective interventions, such as family therapy and making a concerted effort to find people jobs, were not being widely used.

Paul Jenkins, head of Rethink Mental Illness, was also a member of the commission.

He said: “It’s been over 100 years since the term ‘schizophrenia’ was first coined, but care and treatment are still nowhere near good enough.

“It is a scandal that in 2012 people with schizophrenia are dying 15-20 years earlier than the general population.”

The report said tackling those physical health consequences would take many years, but made economic sense.

And it highlighted poor prescribing practice as another problem faced by people with schizophrenia, saying patients were not always receiving the most effective medication.

The report – titled The Abandoned Illness – concludes patients can be given hope and support, with the aim of stability or recovery.

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