Dr Simon Clarke ~ Living in Glass-Walled Asylums: The Schizophrenia Commission Report

Last week the Schizophrenia Commission, headed by the mental health charity Rethink, released its report into the current state of care in the UK for people diagnosed with Schizophrenia. It made predictably depressing reading. Amongst other things, employment rates for people diagnosed with schizophrenia are less than 7%. The life expectancy rates are 15-20 years lower than the general population due to physical health-related problems. These health problems are often associated with weight gain, side-effects from powerful anti-psychotic medications. A huge proportion – 87% – of service users report experiences of stigma and discrimination, whilst the cost of schizophrenia to the economy was estimated at around £11.8 billion.

Perhaps even more depressing was report’s findings into the current state of mental healthcare in the UK for people diagnosed with schizophrenia. Mainstream psychiatric care was described as “a broken and demoralised system that does not deliver the quality of treatment that is needed”, in which service users “feel shuttled from one team to another as if on a factory production line”. Inpatient wards are often “frightening places where the overwhelmed nurses are unable to provide basic care and support” and in some cases “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”. Too often, “medication is prioritised at the expense of the psychological interventions and social rehabilitation” and genuine service innovations like Early Intervention is Psychosis (EIP) teams are “vulnerable to service cuts”. The net result of all this is that psychiatric care “adds greatly to their distress and worsens the outcomes for what can already be a devastating illness”.

As someone who has experienced psychosis, been sectioned, diagnosed with schizophrenia, spent time in an alternative therapeutic community, qualified as a clinical psychologist and worked for two years in an EIP service in London, I can relate to much of this. I found my inpatient stays traumatic and demoralizing. As a result of medication I put on four stone of weight in 6 months. I used cannabis to cope, which of course led to more long-term problems. Thankfully I was helped by an alternative therapeutic community; the love and kindness showed by people in the community helped repair some of the damage from my experience as a psychiatric service user. Supportive but challenging relationships were key, as in fact they always are (Pilgrim et al., 2009).

So before we become self-satisfied with smug complacency about having better attitudes towards severe mental illness than wider society, perhaps we should get our own, crisis, house in order. Attitudes amongst mental health staff can still reflect negative, and inaccurate, expectations of people diagnosed with schizophrenia; in one study for example (Nordt et al., 2006), psychiatrists’ attitudes were more negative than the general population. Health professionals with past or present experience of mental health difficulties are often less likely to disclose their problems to colleagues than people outside the health service (Hinshaw, 2008).

When I was working at a large, well-known mental health research institution a senior colleague once told me, “you only got the job because of your psychiatric history, not because you are a good researcher”. When, whilst working at another NHS Trust, a confused visitor looking for an A & E department was told by a receptionist, “No, no love you’ve got it wrong; this is not a real hospital, this is a hospital for mental people”. The receptionist helpfully added a circular motion beside his head to illustrate what he meant by ‘mental’, just in case the flummoxed visitor (and, presumably, the patients and carers waiting in reception) didn’t understand.

Those in glass houses…

Posted by:
Dr Simon Clarke
Clinical Research Psychologist
Nottinghamshire Healthcare NHS Trust

References:
The Schizophrenia Commission Report (2012): http://www.schizophreniacommission.org.uk/the-report/.

Hinshaw, S.P. (2008) Breaking the Silence: Mental Health Professionals Disclose Their Personal and Family Experiences of Mental Illness. New York: Oxford University Press.

Nordt, C., Rossler, W. & Lauber, C. (2006) Attitudes of Mental Health Professionals Toward People With Schizophrenia and Major Depression. Schizophrenia Bulletin 32(4): 709–714.

Pilgrim, D., Rogers, A. and Bentall, R. (2009) The Centrality of Personal Relationships in the Creation and Amelioration Mental Health Problems: the current interdisciplinary case. Health: an interdisciplinary journal for the social study of health, illness and medicine 13(2): pp.235-254.

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