For years the word ‘schizophrenia’ has been whispered, with people either ignorant or fearful of what it means. Many families have often kept it a secret due to the stigma that surrounds it. Yet this is not a rare condition. It affects 220,000 people in England – from any background at any age – and costs the NHS more than cancer or cardiac disease.
One hundred years after the term ‘schizophrenia’ was coined, things are beginning to change. The Schizophrenia Commission’s report ‘The Abandoned Illness’ and the National Audit of Schizophrenia have been published over recent weeks. The reality of living with the condition has been exposed – some of which makes for very uncomfortable reading.
People with schizophrenia die 15-20 years earlier than other citizens, mainly due to their physical health being neglected. Given this high risk, you’d think that people’s physical health needs would be a priority, and that NICE guidelines calling for an annual physical health check would be implemented. Yet less than 30% of people with schizophrenia receive this basic level of support.
Unfortunately people’s concerns are sometimes seen as manifestations of their illness. A member recently told us that she turned up to A&E with a ruptured ankle tendon. Due to her mental health condition she was refused a medical exam and told to go and see her Community Psychiatric Nurse instead. I’ve heard many cases like this – sometimes involving cancer fears which are ignored until it’s too late.
But it can be different. This year we have heard from thousands of people affected by mental illness, their health professionals and commissioners. It quickly became clear that psychiatrists often thought GPs were taking care of their patients’ physical health, and vice versa. To overcome this, we’ve worked with the Royal Colleges to create an Integrated Physical Health Pathway to prevent people’s care falling between primary and secondary care. We have also created e-learning, physical health checks and other free support tools for professionals, and a guide to help people with mental illness to care for their own health.
Other measures – from bringing diabetes and cardiac nurses into mental health inpatient units to public health teams creating smoking cessation programmes tailored to people with enduring mental health needs – are leading to improvements. In Lancashire they use our Physical Health Check and told us that more than half of the people they assessed had a physical health problem, but didn’t know about it.
Related to this, side effects of medication remain a real problem. Progress in this area of research has been woefully slow – the best drugs available were developed in the 1960s and haven’t vastly improved since then. This leaves people with very difficult decisions around taking their meds and enduring life threatening side effects, or not taking them and being overwhelmed by symptoms. Government, academia and industry must urgently act to develop new medications and treatments for psychosis.
We’re pleased that this Government has called for parity between mental and physical health in the NHS Mandate. But for this to be realised we need system-wide change. 20% of the mental health budget is currently spent on secure care. When visiting such a unit recently, I met a number of people who had been deemed clinically fit to return to community care. However, a battle was taking place between the local authority and NHS in these areas around where they would live and who would pay for it. In the meantime they were locked away. This system could be transformed which would allow very significant savings to be reinvested into the community to provide early intervention services, crisis care and psychological therapies.
Following the publication of the Schizophrenia Commission’s report, at Rethink Mental Illness we're working with our members and colleagues across the NHS to turn its recommendations into practical action. Join us in transforming this diagnosis of despair.
Victoria Bleazard is Associate Director for Policy, Research and Campaigns at Rethink Mental Illness, www.rethink.org/