Schizophrenia--time to commit to policy change

Abstract

Care and outcomes for people with schizophrenia have improved in recent years, but further progress is needed to help more individuals achieve an independent and fulfilled life. This report sets out the current need, informs policy makers and all relevant stakeholders who influence care quality, and supports their commitment to creating a better future. The authors recommend the following policy actions, based on research evidence, stakeholder consultation, and examples of best practice worldwide. (1) Provide an evidence-based, integrated care package for people with schizophrenia that addresses their mental and physical health needs. (2) Provide support for people with schizophrenia to enter and to remain in their community, and develop mechanisms to help guide them through the complex benefit and employment systems. (3) Provide concrete support, information, and educational programs to families and carers on how to enhance care for an individual living with schizophrenia in a manner that entails minimal disruption to their lives. (4) All stakeholders, including organizations that support people living with schizophrenia, should be consulted to regularly revise, update, and improve policy on the management of schizophrenia. (5) Provide support, which is proportionate to the impact of the disease, for research and development of new treatments. (6) Establish adequately funded, ongoing, and regular awareness-raising campaigns that form an integral part of routine plans of action. Implementation of the above recommendations will require engagement by every stakeholder, but with commitment from all, change can be achieved.

Keywords: antipsychotics; health policy; psychotherapy; quality of life; recovery; schizophrenia.

Fig. 1.

Burden on family carers: what is the bigger picture? At the age of onset of a child’s mental illness, the age of family carers (40–60 years) and the possibility of separation or divorce mean that they are at a time of great family stress and pressure. Reproduced with permission from EUFAMI.

Fig. 2.

Caring for somebody with a mental illness can take its toll on the carer. The figure shows issues faced by carers in a survey by the US National Alliance on Mental Illness.

Fig. 3.

Total costs of schizophrenia and diabetes mellitus in the United States in 2002 (US dollars). Indirect costs account for a higher proportion of the total costs of schizophrenia compared with some common (and expensive) conditions such as diabetes mellitus. ^aIndirect costs comprised absence from work, caregiver burden, premature mortality, and reduced productivity at work. ^bDirect costs comprised outpatient care, medication, inpatient care, and long-term care. ^cIndirect costs comprised disability, reduced productivity, premature mortality, and absence from work.

Fig. 4.

Long-term (maintenance) antipsychotic medication significantly reduces the number of relapses (at 7–12 months) and the number of hospitalizations in patients with schizophrenia, compared with placebo (data from a combined analysis of 65 clinical trials).

Fig. 5.

Family psychoeducation reduces schizophrenia relapse rates, compared with treatment without family psychoeducation, and multifamily group psychoeducation is particularly effective.

Fig. 6.

The Individual Placement and Support model of supported employment can demonstrate substantial savings in health care and societal costs. The figure shows estimated savings (in British pound sterling) per patient, using UK data from the Enhancing the Quality of Life and Independence of Persons Disabled by Severe Mental Illness Through Supported Employment (EQOLISE) study.^, Figure adapted from Andrew et al.

Fig. 7.

On average, people with schizophrenia die earlier than the general population. The figure shows the mean decrease in life expectancy at birth in people with schizophrenia, compared with the general population, in London, UK.

Fig. 8.

Intensive information campaigns have been shown to have a beneficial effect on the duration of untreated psychosis. The figure shows the proportion of patients with a given duration of untreated psychosis in the presence or absence of information campaigns. People are more likely to seek help when information campaigns are in progress, so the duration of untreated psychosis is shorter. Figure adapted from Joa et al.