Patient care of schizophrenics at 'all-time low', claim experts
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Wednesday 14 November 2012
Last year almost 49,000 patients were detained against their will under the Mental Health Act 2007, the highest level since the act was introduced five years ago. Black and Afro-Caribbean men are disproportionately represented among those who were detained.
While the numbers in secure care rise – consuming 19 per cent of the total mental health budget – the early intervention service which has been shown to prevent descent into long-term mental ill health – is being cut.
The 14-member Schizophrenia Commission, chaired by Sir Robin Murray, professor of Psychiatric Research at the Institute of Psychiatry, King's College London, says that switching funds from secure care to early intervention would prevent illness and save money – an average of £16,000 per patient treated over the first three years of their illness.
It calls for a complete overhaul of in-patient units, the elimination of poor prescribing, improved access to psychological therapies, stronger warnings on prevention – including the risks of smoking cannabis, improved services for ethnic minorities and more choice for patients.
"Good care delivered by kindly, compassionate practitioners can make all the difference. Hope is central to recovery. Time and time again we heard of a transformation whereby an apparently downward course was reversed by a doctor or therapist who took the time to listen and understand," the report says. The Commission held six public meetings around the country at which experts, patients and carers gave evidence, and conducted online surveys which elicited 2,500 responses. It says it is "unacceptable" that:
* People with mental illness die up to 20 years before their time;
* Levels of coercion are increasing, by 5 per cent in the last year;
* In-patient wards are frightening, overcrowded and make patients worse, not better;
* Drugs are mis-prescribed, given in excessive doses and carry unpleasant side effects;
* Psychological therapies are offered to one in 10 of those who could benefit;
* No new medications have been developed since the 1960s;
* Staff are demoralised and burnt out and pessimism pervades the system.
Despite a doubling in spending over the last decade, mental health consumes just 13 per cent of NHS resources while accounting for 23 per cent of the disease burden. Experts fear recent cuts to mental health services following the squeeze on the NHS budget will make the situation worse.
Professor Murray said: "The system is pervaded by pressure to avoid risk rather than by the need to provide care. Too many people are locked up for too long. A sensible policy towards risk would allow us to reduce spending on secure units and plough more money into other services."
A Department of Health spokesperson said: "The new mandate for the NHS includes plans to hold the NHS to account for improving health and reducing premature deaths in people with serious mental illness. People with mental health problems should be treated with the same high quality and dignified care as anyone else."
Schizophrenia: The causes – and effects
The term schizophrenia was first used by the Swiss psychiatrist Eugen Bleuler in 1911 to describe the experience of hallucinations (especially voices), or delusions (false beliefs) which may give rise to odd behaviour.
There is no single cause. Both genes and environment play a part. People born with a pre-existing vulnerability may develop the illness as a result of heavy use of drugs (cannabis and amphetamines), being bullied or abused, being an immigrant or living in a city. Trauma, such as bereavement or divorce, can also trigger the condition. One of its most misunderstood aspects is that in many sufferers it is not a permanent state, but an episodic one.
People diagnosed with the illness are not "mad" – they are sometimes mad and sometimes sane. Not so different from the rest of us, it might be said.
About 45 per cent of those diagnosed with the condition later recover after one or more episodes. Of the remainder, 35 per cent follow a pattern of relapsing and remitting; only one in five suffer permanent disability.
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