The Role of Work and Community in the Treatment of Schizophrenia

Colorado Recovery founder Richard Warner, M.D., helped develop a comprehensive community support system for people with serious mental illness that earned him international acclaim. The system includes a residential treatment program for patients with serious mental illness (originally called Cedar House later renamed Warner House), at which the late Dr. Warner was the chief psychiatrist.

When Warner started out as a psychiatrist, schizophrenia was mostly considered chronic and incurable. Patients were often heavily medicated and frequently confined in state hospitals. However, through statistical analysis in the early eighties, Warner discovered that a significant number of people with schizophrenia do achieve full recovery. 

“The popular and professional view that schizophrenia has a progressive, downhill course with universally poor outcome is a myth,” Warner wrote in his book The Environment of Schizophrenia in 2000. “Over the course of months or years, about 20 to 25 percent of people with schizophrenia recover completely from the illness; all their psychotic symptoms disappear and they return to their previous level of functioning. Another 20 percent continue to have some symptoms, but they are able to lead satisfying and productive lives.”

Warner found that the only exception to those outcome statistics was the period of the Great Depression in the 1930s when full recovery was closer to ten percent. Why was that? he wondered. 

It occurred to Warner that the decisive difference was the lacking opportunity to work because of the economic downturn. Without the chance of being productive members of the community, patients with schizophrenia had worse outcomes.

“Work helps people recover from schizophrenia,” Warner concluded. “Productive activity is basic to a person’s sense of identity and worth. The availability of work in a subsistence economy may be one the main reasons that outcome from schizophrenia is so much better in Third World villages. Given training and support, most people with schizophrenia can work.”

The reverse is also true. Locking them up can exacerbate their illness:

“People with schizophrenia can get worse if treated punitively or confined unnecessarily,” wrote Warner in The Environment of Schizophrenia. “Extended hospital stays are rarely necessary if good community treatment is available. Jail or prison are not appropriate places of care.” 

Medication therapy remains important but it can only be part of the solution.

“Medications are an important part of treatment but they are only part of the answer. They can reduce or eliminate positive symptoms but they have a negligible effect on negative symptoms. Fortunately, modern, novel antipsychotic medications, introduced in the past few years, can provide benefits while causing less severe side effects than the standard antipsychotic drugs which were introduced in the mid-1950s.”

According to Abraham Maslow’s famous hierarchy of needs all humans have basic physiological needs and long for a safe environment. But they also need “belonging and love” and a sense of accomplishment (esteem) as well as “self-actualization” to thrive. People with serious mental illness are no exception. 

“Treatment should include social rehabilitation,” wrote Warner. “People with schizophrenia usually 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; and job training, job placement, and work support.”

Warner taught that “Productive activity is basic to a person’s sense of identity and worth. The availability of work in a subsistence economy may be one the main reasons that outcome from schizophrenia is so much better in Third World villages. Given training and support, most people with schizophrenia can work.”

Colorado Recovery is utilizing the Warner method to empower adults with mental illness, and those who support them, with an unrelenting optimism for recovery, purposeful involvement in the community, and an enhanced sense of meaning in life.

Created by Dr. Richard Warner, the Colorado Recovery program approaches care for mental health based on a path of self-reliance through developed practiced skills. This non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation. Those under 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.