Community Care Treatments of Schizophrenia

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Community Care

Became possible after the introduction of neuroleptic medication in the 1960's. This resulted in mass deinstitutionalisation as it was now possible to treat individuals in the community.

Effective community should include:

  • Access to medication
  • Psychotherapy
  • Residential supervision
  • Support in daily life and responsibilities
  • CO-ORDINATION of patient services, halfway house and occupational training
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Benefits of Community Care

  • Removes the stigma attched to institutionalisation
  • The individual no longer has to adhere to the label of 'patient'--> Rosenhan's research (ordinary citizens admitted into psychiatric hospitals and taking an average of 19 days to be allowed to get home) illustrated how labelling can maintain symptoms and increase the risk of relapse
  • Many sufferers are able to reintegrate with their families and engage in more normal day-to-day living, which helps to promote social contact
  • Patients are able to live away from the psychiatric hospitals that have been shown to dehumanise sufferers
  • Scott et al- good community care leads to greater progress in patients compared to those living in institutions
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Halfway Houses

  • Residences for people who do not require hospitalisation but cannot live either alone or with their families
  • Normally shelter between one and two dozen people with live-in stagge usually consisting of paraprofessionals
  • Usually run with a mileu therapy philosophy that emphasises support, resident responsibility and self-government
  • Simpson et al- found that halfway houses help many people recovering from schizophrenia adjust to community life and avoid rehospitilisation

NIMBY

  • 'Not In My Backyard' syndrome
  • An unwillingness of the general public to accept the mentally ill into their community
  • Lead to problems with getting planning permission for halfway houses, the implications of which are that there is a shortage of this type of provision for recovering schizophrenics
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Occupational Training

Employment for recovering schizophrenics is improtant as it encourages them to support themselves, exercise independance, gain self respect and learn to work with others.

Sheltered Workshops

  • A protected and supervised workplace for people who are not ready for complicated and competiitve jobs
  • Tries to establish a typical work environment and so acts as a way of easing someone back into the world of work
  • Workers are paid according to their performance and time keeping
  • For some this is a permenant workplace whereas for others it is a stepping stone towards better-paying and more complex outside employment
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Issues with Community Care

  • Von Korff et al- Less than half of all people with schizophrenia receive appropriate mental health services
  • Torrey, Regier et al- found that almost 40% of all people with schizophrenia fail to receive any treatment at all in any given year
  • Poor communication is often responsible for the failure of community programmes- conflicting advice, patients don't experience a smooth transfer from hospital to community
  • Services often devote their efforts and money to outpatient service for people with less disabling problems e.g. anziety and depressive disorders, this results in a shortage of programmes for schizophrenic patients
  • Revolving door syndrome- a lack of communtity care means the individual is more likely to relapse and as a result be forced to return back to hospital only to be released agan once they have re-stabilized
  • Cost

Adressing the issues

  • Case managers are now appointed to deal with an individual schizophrenic patient, resulting in more tailored care that is specific to their needs
  • Improving communication means that the transition to the community is more effective
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