People with schizophrenia can be treated effectively in a variety of settings with hospitalization mostly reserved for acute cases. Outside of a hospital environment, treatment should include social rehabilitation. People with schizophrenia typically need help to improve their functioning in the community. This can include training in basic living skills, assistance with a host of day-to-day tasks, job training, job placement, and work support.
Sadly this aspect of treatment is frequently missing. “Lacking a useful social role, many people with mental illness face lives of profound purposelessness,” wrote the late Colorado Recovery founder Richard Warner, MD, in The Environment of Schizophrenia (2000).
This situation leads to severe functional deficits in schizophrenia, In a recent presentation for Psych Congress Network, Leslie Citrome, MD, MPH, clinical professor of psychiatry and behavioral sciences at New York Medical College, Valhalla, NY, in a recent presentation for Psych Congress Network about he importance of psychological rehabilitation, such as cognitive remediation and vocational rehabilitation in the treatment of schizophrenia.
The numbers are quite shocking. “Only 10 percent of all patients with schizophrenia work full-time. Only one-third ever worked part-time,” said Citrome. “Fewer than 10 percent of male patients with schizophrenia have a child, and the self-care deficit is reflected in high rates of medical comorbidity.”
These deficits are a big problem but there are things that can be done to change the situation. “Cognitive behavioral therapy or CBT, although it’s labor-intensive, can be helpful, even in patients considered treatment-refractory, and has been evaluated in controlled clinical trials in patients with treatment-resistant schizophrenia,” explained Dr. Citrome.
“Cognitive remediation is a very specific type of treatment. It’s a set of drills or interventions designed to enhance cognitive functioning. It’s a therapy that engages the patient in learning activities that enhance neurocognitive skills relevant to their chosen recovery goals. It’s very personalized.”
Ultimately, psychosocial rehabilitation includes improving functional and subjective outcomes. It consists of is a range of techniques, including CBT and cognition remediation, as well as addressing patient employment.
Meaningful employment is an important aspect of the treatment model originated by Dr. Warner. Clinical research shows that “patients discharged from psychiatric hospital who have a job are much less likely to be readmitted to hospital than those who are unemployed, regardless of the patient’s level of pathology,” as Dr. Warner wrote The Environment of Schizophrenia.
Dr. Citrome agreed. “One of the key goals in psychosocial rehabilitation is helping patients live independently and be employed. Employment is identified as a goal for most of our patients. They’ll tell us on many occasions, ‘Yes, I’d like to have a job.’”
There are multiple barriers to employment that need to be addressed starting with the psychiatric symptoms. In addition, there may be substance misuse, non-psychiatric medical conditions, stigma from employers, internalized stigma, and low self-confidence—even the fear of losing disability benefits.
“Vocational rehabilitation addresses these barriers by providing skill training, sheltered workshops, transitional employment, and supported employment, as well as the maintenance of benefits,” said Citrome.
Finding appropriate employment for patients is an important part of the treatment plan at Colorado Recovery. Employment support includes helping clients find a job, go back to school, or find volunteer work in the community.
“Patients who received both cognitive remediation and vocational rehabilitation demonstrated significantly greater improvements on a cognitive battery over three months than those who received vocational rehab alone and had better work outcomes over the two-year follow-up period,” explained Citrome. “A comprehensive approach is better, and for those community settings that can offer this, their patients are better off. With employment, one may expect increased self-esteem, reduction in symptoms and hospitalizations, enhanced social functioning, and improvement in overall quality of life.”
Empowerment and vocational rehabilitation are crucial elements of the Warner model. “Work helps people recover from schizophrenia. Productive activity is basic to a person’s sense of identity and worth,” Dr. Warner wrote. “Given training and support, most people with schizophrenia can work.”
The Colorado Recovery program approaches mental healthcare with a focus on self-reliance through developed practiced skills. Our non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation. Those in our care go to school, volunteer, or are employed in the beautiful surrounding Boulder area where they regularly take advantage of all it has to offer recreationally.
Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.