MENTAL HEALTH
He said: “There is a tendency at present to adopt a form of assembly line treatment. Somebody sees a psychiatrist as an outpa- tient, then becomes ill and is passed on to a crisis intervention team.
“They could then be admitted into hospital for a week, before being passed on to an- other inpatient unit, then a rehabilitation unit.
“It’s demoralising to have to tell your en- tire life story over and over again to people you know you’re only going to see for a few days. This loss of continuity of care is one of the disadvantages of the current system.”
Another objective for the commission is to investigate the lack of choice available to people with schizophrenia, and why al- ternative options are even more vital for people with mental health problems than for those with physical illness.
Sir Robin said: “If you have a physical ill- ness you can choose your GP. For an op- eration you can choose which hospital has the lowest waiting list or the best recovery times. People with psychiatric illness don’t have this option.
“If you don’t get on with the psychiatrist in your area, it is very diffi cult, because you don’t have the choice to say that you would rather go somewhere else. It’s probably even more important for mental illness.
“If you’re being operated on by a surgeon you don’t like, it won’t make much differ- ence to your treatment. But if you’re telling someone about your life, and the particular things that upset you then it makes a dif- ference. This lack of choice is one of the big problems.”
Competition and choice
One of the objectives of the new Health & Social Care Bill is to increase the amount of competition in the NHS. Sir Robin suggests that this could improve care, but only if the choice is focused on the patient.
He said: “It depends if it brings increased choice. If some private company takes over all the services in a certain hospital the problem could remain the same. I don’t think that swapping a monopoly NHS for a monopoly private service would help.
“But if the individual patient, with their GP, has the choice to decide which services they would like to go to then that could be benefi cial. It has to be the patient’s choice rather than the services in one area just been taken over by a particular company.”
Mortality rates
The mortality rate of people with schizo- phrenia is a particular concern for the com- mission, as the difference between their death rate and the normal population’s death rate is increasing.
This trend started to occur over the last ten years, due to the introduction of a new type of medication, and the additional problems of smoking and obesity.
Sir Robin said: “People with schizophrenia tend to be heavy smokers, and psychiat- ric hospitals still allow smoking, strangely, whereas general hospitals don’t. Most of the wards have a smoking room or facility so this is something that needs to be looked at.
“About ten years ago, a new type of anti- psychotic medication came in that increas- es the tendency for people to put on weight. It has fewer side effects in other areas, but it means patients are more prone to de- velop obesity, diabetes and heart attacks. Sadly that’s been a side effect of the newer treatment.”
Public recognition
The gains in understanding schizophrenia should lead to a reduction in stigmatisa- tion that patients face, in public as well as in the health service. However, more public awareness is still necessary.
Sir Robin said: “Now we understand a lot more about it there’s much less need to be frightened of it. A lot of people recover from schizophrenia but unfortunately they don’t go on TV and say that in the same way that they could do with cancer. The good news about schizophrenia doesn’t get publicised.”
Recognition of the importance of mental health in today’s society varies, Sir Robin said. More celebrities are publicly reveal- ing their own mental health disorders nowadays, although the stigma relating to schizophrenia means that this condition still lacks such positive exposure.
Sir Robin commented: “I would be really pleased if we got to a situation where come- dians were claiming to have schizophrenia, but sadly not. People recognise anxiety, bipolar disorder and Alzheimer’s disorder but schizophrenia is still the one that is stigmatised.”
Risk averse
This stigma takes its strongest form in the last place you might expect; the health ser- vice itself. Sir Robin suggested that manag-
ers in the NHS are often unsympathetic to any staff with schizophrenia, due to their disposition to minimise potential hazards.
Sir Robin said: “Often managers are scared. Most people with schizophrenia can work perfectly well, but many people in managerial roles in the health service are risk averse. They do not want to fi nd out somebody is being treated for schizophrenia, they think that it means that they’re going to do something absolutely daft.
“Some trusts are brilliant at it but in my experience, the average acute trust is not very open-minded. To be honest, the health service is worse than some other employers: they’re just more prejudiced.”
The way to improve this situation is to con- tinue to raise awareness of how the condi- tion affects people, Sir Robin suggested.
“Only a small minority of people with schizophrenia get progressively worse. Many people have one episode then recover; others have one episode and then take their medication and go on to have a normal life. I don’t think that’s so widely known yet, that’s one thing we hope there could be more pub- licity about,” he explained.
Sliding scale
Schizophrenia used to be considered a dis- crete disease, totally separate from ‘nor- mality’. Now it is believed to resemble a sliding scale, with no absolute cut-off point between those diagnosed with the condi- tion and those without.
Sir Robin explained: “It’s not as if 98% of the population is slim and 2% are grossly obese: there is a distribution. It’s the same with schizophrenia – it’s not like 99% of the population are entirely sane and 1% has schizophrenia.
“One of the things we’ve learnt is that a lot of people have the capacity to develop schizophrenia if they just have a serious or very unfortunate social situation.”
Visit
www.schizophreniacommission.org.uk Sir Robin Murray
FOR MORE INFORMATION national health executive Nov/Dec 11 | 49
This new perspective, alongside greater clarity over causes, could help the health sector, and the wider population to un- derstand, accept and support people suf- fering from schizo- phrenia.
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