Mental health conditions

Schizophrenia

Related help and contacts

Quick links on this page:

• What help will I be offered?
• What can I do to improve my life?
• Are people diagnosed with schizophrenia dangerous?
• What can partners, friends or relatives do to help?
• Contacts

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What help will I be offered?

The National Institute for Clinical Practice (NICE) has produced guidelines for treating and managing schizophrenia. It covers psychological treatments, medication and the services that should be provided in hospital and in the community. The guidelines aim to maximise people's recovery, freedom from relapse, quality of life, independence, work prospects and social integration. NICE suggests that people should get help as quickly as possible.

If you decide to see your GP, he or she will probably refer you to psychiatric services for initial assessment, treatment and care. However, once treatment is established, your GP can be responsible for your ongoing care.

Medication

Doctors usually prescribe neuroleptic drugs (also known as anti-psychotic drugs or major tranquillisers) to control the 'positive' symptoms. They have a sedative action, which can make it more difficult to cope with side effects or to benefit from talking treatments. They may also have unpleasant side effects, particularly in high doses. These include neuromuscular effects (trembling hands and muscle stiffness) or anti-muscarinic effects (blurred vision, rapid heart beat, constipation and dizziness). Older neuroleptics, such as chlorpromazine (Largactil) and haloperidol (Serenace, Haldol) have been associated with severe and longterm side effects, including permanent damage to the central nervous system (known as tardive dyskinesia).

Some people get short-term help from medication, then come off it and remain well. Others may benefit from more long-term treatment. For these people, staying on the lowest effective dose of the drug may be the best way of dealing with symptoms, as well as lessening any side effects. If you are taking these drugs, you should have the dosage reviewed regularly, with the aim of keeping it as low as possible. It may take trial and error to find the best form of medication for you. It may make a big difference to symptoms, or none at all. Some people stop taking it because of the side effects, others find they don't need it.

Talking treatments such as psychotherapy, counselling and cognitive behaviour therapy (CBT), can help people to overcome schizophrenia, by recognising their problems, dealing with its consequences, developing coping strategies and learning how to prevent crisis situations developing. It can allow them to explore the significance of their symptoms, and so to defeat them. NICE guidelines underline the importance of making CBT and family therapy available, so ask your doctor about this. Otherwise, accessing talking treatments can be difficult if you can't afford to pay. Some local voluntary projects, including local Mind associations, offer free services.

Community care – everyone referred to psychiatric services should have a thorough assessment of their health and social care needs, a care plan and ongoing reviews of their progress. A care coordinator should be in charge of each case. You are entitled to say what your needs are, and have the right to have an advocate present. The assessment might also include carers and relatives.

Your local Community Mental Health Teams (CMHT) may make the care assessment. CMHTs are made up of a number of specialist workers, including a psychiatrist. Their job is to enable you to live independently, and to help with practical issues, such as sorting out welfare benefits and housing. They can also organise access to day centres or drop-in centres. A community psychiatric nurse (CPN) may visit you at home. CPNs administer injections, and may provide other practical help. An occupational therapist may also be on the team and can help you develop new skills.

Crisis services – CMHTs, home treatment teams, early intervention teams and acute day hospitals may help people in a crisis to avoid going into hospital. Some of these offer accommodation, others aim to send support into people's own homes. However, they are not yet available accross the country.

Hospital admission – If you are feeling particularly distressed, you may prefer to go somewhere that feels safe and undemanding. At present, this usually means going into hospital. It can be upsetting to be around others who are distressed, and the lack of privacy and support can also be difficult to cope with. However, service user or patient groups based in the hospital can be very useful and supportive.

Advocacy – advocates are trained and experienced workers whose role is to assist people to communicate their needs or wishes, to access impartial information, and to represent their views to other people. Advocates based in your hospital, or local mental health groups, including Mind, can offer support and advice about coping with drugs and treatments and how to get alternatives to them. They may also be able help you access community care services.

Supported accommodation – Social Services and mental health projects, including some local Mind associations, may provide local supported housing. This allows people to live independently, but with help at hand from staff or other tenants, if necessary. Levels of support will vary from place to place.

What can I do to improve my life?

Most people who are diagnosed with schizophrenia recover. A third of people diagnosed only ever have one experience of it and a further third have occasional episodes. Others have to live with schizophrenia as an ongoing problem.

Self-help – these groups provide an important opportunity for individuals and families to share experiences and ways of coping, to campaign for better services, or simply to support each other.

Work – it may be important that you avoid too much stress. If you have a job, you may be able to work shorter hours, or to work in a more flexible way.

Alternative therapies – some people diagnosed with schizophrenia find complementary therapies help them to keep on top of their problems. These might include homeopathy and creative therapies focused on art and poetry. Tai chi, yoga and relaxation techniques can also be of benefit, although it might be a good idea to discuss the possibilities beforehand with a qualified teacher.

Looking after yourself – recent studies have looked at the possible advantages of improved nutrition for those diagnosed with schizophrenia. Some studies have suggested the benefits of EPA-rich fish oils that can be found in sardines, pilchards and supplements. A generally healthy life style is likely to be beneficial. This might include avoiding too much stress, eating well, and getting sufficient exercise and sleep.

Are people diagnosed with schizophrenia dangerous?

Sensational stories tend to depict 'schizophrenics' as dangerous unless drugged and kept in institutions. The facts speak otherwise. The number of homicides committed by people with any mental illness diagnosis is very low. Most people diagnosed with schizophrenia don't commit violent crimes. People with drug or alcohol problems are twice as likely to commit a violent crime as someone diagnosed with schizophrenia.

What can partners, friends or relatives do to help?

Families can have a vital role in helping recovery and reducing the likelihood of relapse. You may be unsure what you should do. But your friend or relative wants the same things we all do: to feel cared about, not to feel alone, and to have someone they can discuss feelings and options with. It's very important to avoid either blaming the person or telling them to 'pull themselves together'.

Find out about the reality of schizophrenia. This could include learning about the different coping strategies, which you could encourage your partner, friend or relative to try. It may be helpful to discuss with the person, when they are feeling OK, what it is they want from you when, and if, they do experience a crisis. It can also be useful to state clearly what you feel you can and can't deal with. It can be difficult to know how to respond when your friend or relative sees something or believes something you don't. Rather than confirming or denying their experience, it may help if you say something like, 'I accept that you hear voices or see things in that way, but it's not like that for me'. It's usually more constructive to focus on how the person is feeling, which may make it easier for you both to communicate constructively. One of the recommendations that NICE has made is that families should be offered psychological support or family therapy, if possible. You might need to provide practical help. If you do act on the person's behalf, it's important to consult them and not take over. It may also be possible to find an independent advocate to act on their behalf (see above). Local mental health projects, including local Mind associations, may be able to help.

If you feel there's a serious risk that harm may come to the person, or to anyone else, it may be necessary to think about compulsory hospital admission, as a last resort. The Nearest Relative, as defined under the Mental Health Act 1983, can request a mental health assessment from an Approved Social Worker, to look at treatment options and decide whether someone should be detained.

It can be very shocking when someone you are close to experiences the symptoms of schizophrenia. It's important to get support in coping with your own feelings, which may include anger, guilt, fear or frustration. A number of voluntary organisations provide help for carers. You are entitled to have your own needs for practical and emotional support assessed by Social Services.

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