Published on 14 Nov 2012 Sections

‘Catastrophic failings’ of schizophrenia care

An independent inquiry into the state of care for people with schizophrenia and psychosis in England is calling for a radical overhaul of the system.

The report, The Abandoned Illness, describes standards of care on some acute mental health wards as “shameful”.

The commission which produced it was set up by the charity Rethink Mental Illness and was made up of a panel of scientists and experts in health and social care.

It says too much is spent on secure care, which is the most expensive form of care, instead of investing in prevention such as psychological treatments and community support.

It finds some wards make patients worse rather than better and that only 10 per cent of people with schizophrenia are currently offered potentially life-changing psychological therapies, which are clinically proven to work and have been recommended by the health watchdog, the National Institute for Clinical Excellence (NICE).

‘Badly let down’

Professor of psychiatric research at Kings College Sir Robin Murray, who chaired the commission, said: “The message that comes through loud and clear is that people are being badly let down by the system in every area of their lives.

“Inadequate care that many people with psychosis receive greatly adds to their distress and worsens the outcomes for what can already be a devastating illness.

“Most have a period in a psychiatric hospital unit, but too many of these wards have become frightening places where the overwhelmed nurses are unable to provide basic care and support.

“The pressure on staff means that medication is prioritised at the expense of the psychological interventions and social rehabilitation which are also necessary.

“Furthermore, some wards are so anti-therapeutic that when people relapse and are in need of a period of care and respite, they are unwilling to be admitted voluntarily; so compulsion rates rise.

Positive or negative

Schizophrenia affects 220,000 people in England, and its symptoms can vary. Schizophrenia is usually classified into one of two categories: positive or negative.

We do not want to return to the days when people with psychotic illness become the ‘abandonati’ of society. Marjorie Wallace

Positive symptoms represent a change in behaviour or thoughts, such as hallucinations or delusions. Negative symptoms represent a withdrawal or lack of function that you would usually expect to see in a healthy person.

For example, people with schizophrenia often appear emotionless, flat and apathetic.

Experts say there are concerns that highly effective early intervention treatment teams are being cut. These are estimated to save the NHS £16,000 per person over the first three years of their illness.

‘I couldn’t do anything’

36-year-old Laura Sherlock was a professional trombone player in her early twenties and toured the world. She was diagnosed with schizophrenia after opening up to her family about feeling suicidal. She was prescribed antipsychotic medication, which she says completely took away her ability to play music.

“The effects of anti-psychotics were awful. I felt numb, deathly tired and barely able to move to think. I couldn’t do anything. When I stopped taking my tablets I was given medication by injections, I had no say in my own treatment.”

Nine years on and Laura is still taking antipsychotic drugs but is also receiving cognitive behavioural therapy (CBT). She added: “I’ve had an amazing psychiatric nurse who challenged my ideas but never rubbished them. I think if all mental health professionals were as respectful, far more people would recover.

“Cognitive behavioural therapy gave me the confidence to start a new career, and I now work at King’s College London Medical School. I use my experiences to teach students about examining patients with mental illness.”

Poorly prescribed

Figures from the report collected by the London School of Economics found that overall schizophrenia costs society £12bn a year from unemployment; institutional costs, health and social costs; unpaid care and premature mortality. This is an average annual cost to society of £60,000 per person.

According to the report, only 13 per cent of the NHS budget goes towards treating mental ill health, even though 23 per cent of conditions dealt with by the NHS are mental health illnesses, not physical.

The report concluded that one third of people affected cannot get quick access to services when they need it, and too often medications are poorly prescribed.

Effective treatment

Cognitive behavioural therapy (CBT) aims to change the way a patient thinks and behaves by working with a therapist. It focuses on the here and now problems and difficulties facing patients, instead of focusing on the causes of their distress.

Although CBT may not work for everyone, experts say it is unlikely to have a negative affect on a patient’s life and is effective in treating depression and anxiety long-term.

Marjorie Wallace, chief executive of the mental health charity SANE, said: “We still do not know the causes of this devastating illness, nor have we developed effective treatments without potentially severe side-effects, or made psychological therapies widely enough available.

“But the real scandal is that despite all the pledges of successive governments, patients are daily being deprived of hospital beds, except on remaining wards which can be so shabby and chaotic they make their conditions worse.

“We do not want to return to the days when people with psychotic illness become the ‘abandonati’ of society, left to fend for themselves in run-down housing, barely supervised hostels, or with their families who, without support, can break under the strain.”

More research

Among the recommendations in the report are the complete overhaul of in-patient units and extended access to psychological therapies, such as cognitive behavioural therapy (CBT) and assertive physical health interventions starting on the in-patient wards.

There are also calls for more research on the causes and treatment of schizophrenia and psychosis, including the development of better drugs with fewer side effects.

Rethink Mental Illness says it will be working with a number of mental health trusts to try to implement the recommendations, which it hopes will act as pilots for other trusts across England.

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