MENTAL HEALTH
Professor Sir Robin Murray, chair of the newly launched Schizophrenia Commission, talks to NHE about the 100th unhappy birthday of the condition.
T
he term schizophrenia was coined 100 years ago, and while our medical un-
derstanding of the condition has advanced, acceptance is still far behind – particularly in the healthcare sector itself, worryingly.
Mental health charity Rethink has used this anniversary to launch the Schizophrenia Commission, which is to review the cur- rent state of support and care for people with schizophrenia, and to suggest im- provements. The commission is currently gathering evidence on this topic, and will publish a report in July 2012.
The chair of the commission, Sir Robin Murray, Professor of Psychiatric Research at the Institute of Psychiatry and Consultant Psychiatrist at the South London and Maudsley NHS Trust, spoke to NHE about raising awareness of schizo- phrenia, a condition which can be more manageable and less damaging than the stereotypes suggest.
Schizophrenia is also more complicated than was originally thought, with several factors that can increase the risk of devel- oping the condition.
Sir Robin said: “We understand a lot more about the causes now. It used to be thought that the causes of schizophrenia were an
48 | national health executive Nov/Dec 11
enigma and there might be just one cause, a particular gene or something in the en- vironment.
“Now we know it’s like a lot of common diseases; there are a number of risk factors. There are susceptibility genes and a mod- est familial tendency and then there are a number of environmental factors such as premature birth, or lack of oxygen at birth, that subtly damage the brain as it is devel- oping, which can increase the risk.
“Taking drugs that alter the levels of dopa- mine in the brain in adolescence; heavy use of amphetamines, cocaine or cannabis can also increase the risk.”
Social fragmentation
Another factor which contributes to higher rates of incidence is living in cities with the level of social fragmentation inherent in that lifestyle.
Sir Robin explained: “It seems to be related to social cohesion. If people don’t know their neighbours or distrust them then the risk is higher.
“The best predictor of incidence according to where you live can be the proportion of people that vote. If you’re in a disorganised
area where nobody cares, nobody thinks voting makes any difference then the inci- dence is much higher. It’s partly related to alienation.”
Counting the cost
Since schizophrenia is a relatively long- term condition, it can involve patients be- ing in and out of hospital for an extended period of time, taking up large numbers of beds. The cost this creates for the health service is equally large, yet constraints on the psychiatric budget may be obstructing patient care.
“Schizophrenia is extremely expensive,” Sir Robin said. “Professionals working in the health service may not fully appreciate these costs. Part of the commission’s work is to urge managers to realise that putting a little bit more investment into the care of people with schizophrenia at the onset and early on might actually save a lot of money in the long run.”
Continuity of care
Sir Robin suggested that treatment for peo- ple with schizophrenia could be improved in several ways, including the promotion of continuity of care rather than a series of disconnected services.
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