There is more agreement now about what is important in the treatment of schizophrenia than ever before. In a recent global project designed to combat the stigma of schizophrenia, prominent psychiatrists from around the world agreed on the following principles:
- People with schizophrenia can be treated effectively in a variety of settings. These days the use of hospitals is mainly reserved for those in an acute relapse. Outside of the hospital, a range of alternative treatment settings have been devised which provide supervision and support and are less alienating and coercive than the hospital.
- Family involvement can improve the effectiveness of treatment. A solid body of research has demonstrated that relapse in schizophrenia is much less frequent when families are provided with support and education about schizophrenia.
- 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.
- Treatment should include social rehabilitation. 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.
- Work helps people recover from schizophrenia. 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.
- People with schizophrenia can get worse if treated punitively or confined unnecessarily. Extended hospital stays are rarely necessary if good community treatment is available. Jail or prison are not appropriate places of care. Yet, around the world, large numbers of people with schizophrenia are housed in prison cells, usually charged with minor crimes, largely because of the lack of adequate community treatment.
- People with schizophrenia and their family members should help plan and even deliver treatment. Consumers of mental health services can be successfully employed in treatment programs, and when they help train treatment staff, professional attitudes and patient outcome both improve.
- People’s responses towards someone with schizophrenia influence the person’s course of illness and quality of life. Negative attitudes can push people with schizophrenia and their families into hiding the illness and drive them away from help. If people with schizophrenia are shunned and feared they cannot be genuine members of their own community. They become isolated and victims of discrimination in employment, accommodation and education.