Aftercare for Schizophrenia
If you were to ask many people on the street “how is schizophrenia treated?” you may be received with a blank stare. You might get some stereotyped responses: “they’re caught and put in jail” or “they are locked in mental institutions”. If they have received some education on the topic, they may reply “they are taken to mental health wards or clinics, where they get diagnosed and medicated”. There is definitely some truth to the last response. People suffering first-onset psychosis or relapse often find themselves in hospital wards or clinics. The psychiatric response may focus on settling or sedating the patient, diagnosing them, and prescribing a suitable medication. Characteristically, a range of symptoms will be called on to justify diagnosis; symptoms such as delusions, hallucinations and/or disordered speech or thoughts.
Obviously there is a great deal more that happens in wards or clinics around people with schizophrenia. The clinic may offer someone a calm, neutral space in which the person’s psychotic symptoms may ebb. Nurses may observe the behaviour of the person during their stay in the clinic. Complex cases of mental illness and co-occurring substance abuse may involve waiting in the ward until the substance abuse disorder passes and doctors can make a more accurate diagnosis of mental illness.
But then what?
Often intensive mental health care ceases. The person with diagnosis and medication are released into the community, left to re-negotiate the same world they came from.
I would like to express, respectfully, that this approach is insufficient. I write as someone diagnosed with schizophrenia, as a consumer advocate and as a consumer who never received aftercare.
I believe that, perhaps almost as importantly as the primary symptoms and medication, people diagnosed with schizophrenia could benefit greatly from aftercare – from services, typically given in the community, that deal with the range of challenges a person released from a ward or clinic may experience.
Take, for example, the issue of post-presentation suicide. It has been reported that there is a spike in suicide attempts in the period just after people coming out of a ward or clinic. Imagine you are experiencing suicidal ideation and feel suddenly at a loss once outside the intensive care of a clinic or ward. Post-presentation support can help monitor and support you.
People with schizophrenia often experience cognitive challenges. Imagine your mind is a bit foggy; your thoughts unclear. This can lead to cognitive challenges in problem solving and abstract thinking. Cognitive remediation is a technique of re-training the brain (so to speak) of the person diagnosed with schizophrenia. With their cognitive skills improved, many people with schizophrenia can make better life choices and succeed in areas of importance to them.
Indeed, the mental illness schizophrenia often does not present on its own. People diagnosed with schizophrenia often have experienced such challenges as trauma, violence, homelessness, familial conflict, unemployment, poverty or substance abuse. Again, in response to this reality, aftercare for the person diagnosed with schizophrenia may be vital in helping that person achieve a state of wellbeing that taking medications on their own cannot achieve. Assertive community treatment, including a range of clinicians and support workers working in the community to help people with diagnosed schizophrenia, is a good example of this. Alternatively, support workers trained in recovery-oriented practice can benefit the diagnosed person – recovery-oriented practice being a holistic approach which focuses on individuals goals and dreams, as well as the person’s abilities and steps to achieve those goals and dreams.
Finally, but of no less importance, is inclusion of the diagnosed person’s family. Typically the family of someone with schizophrenia may not fully understand the disease. They may not appreciate why a family member is acting the way they do. They may not recognise signs of relapse leading to re-hospitalisation. At the same time, it is very often the family who must work as carers for the person diagnosed with schizophrenia. Imagine you are the person diagnosed in this situation, and the confusion that may result.
In response to this reality, the aftercare process known as family intervention has been developed. Family intervention will typically involve some or all members of the family of the person diagnosed with schizophrenia coming together with the person themselves as well as one or more clinicians and some to guide the intervention. Family intervention can be vital in teaching prospective carers about the nature of schizophrenia – the kinds of behaviours and thoughts and emotions both carers and consumers might experience, what might be scary or difficult or challenging, as well as possible solution behaviours. This can improve the quality of care for the diagnosed person which can, in turn, help prevent relapse and shorten re-hospitalisation.
I believe that people diagnosed with schizophrenia can often benefit from support after they have left the clinic or ward. I do not wish to minimize the role of trained and caring psychiatrists using the tools they are given to help the people whom they treat. But it is important not to forget that every person is an individual with their own attitudes, capabilities, dreams and personality, and each person diagnosed with schizophrenia may respond to aftercare – or any care – more or less readily than another. Treating the whole person holistically, in their familial and community context, and addressing all the issues they may face would appear to be vital in successfully maximizing the wellbeing of individuals diagnosed with schizophrenia.
Dr. Richard Schweizer, Policy Officer at One Door Mental Health richard.schweizer@onedoor.org.au.
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Dr Richard Schweizer