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Professor Sir Robin Murray presents key findings from the Schizophrenia Commission in the UK
On July 24, 2013 Professor Sir Robin Murray presented 'The good, the bad and the ugly of Schizophrenia care' at The Alfred, a talk outlining some of the key findings of the Schizophrenia Commission in the United Kingdom. Rethink Mental Illness established the independent Commission in 2011 and it was chaired by Professor Sir Murray. The Commission ran six formal evidence gathering sessions which involved 80 experts, including people who have lived with schizophrenia or psychosis, family members and carers, health and social care practitioners and researchers; 2,500 people also responded to their online survey.
Professor Sir Murray started with the 'good' results of their findings: areas of excellence in schizophrenia care included early intervention teams and home treatment. These were popular because of their holistic approach to care, which promoted engagement with clients and support networks and encouraged self-management and choice, while remaining easily accessible. Respondents emphasised the kindness, competence and hopefulness that these treatment approaches provided.
The 'bad' of schizophrenia care was more discouraging. Respondents disliked not knowing who was responsible for the care being provided, and they found acute care units stark, unwelcoming and frightening places with little for in-patients to do. The insufficient support for nursing staff exacerbated the negative experience hospital care offered. The Commission recommended more support for nurses, with greater opportunities for further training, as well as improved in-patient units. Not all acute care units were as discouraging, and Professor Sir Murray gave the Burgholzli Hospital in Zurich as an example of a mental health facility which provided access to gardens, exercise areas, private rooms and, very importantly, specially trained therapeutic dogs in each ward.
The 'ugly' of schizophrenia care outlined in the talk had as its starting point Kraepelin's description of schizophrenia as a deteriorating illness. A century later and this view of schizophrenia remains widely held resulting in a sense of hopelessness, as well as stigmatisation, for many people diagnosed with schizophrenia. Poor prescribing was another 'ugly' side of schizophrenia care, with people not consulted about the medication they are prescribed and too many psychiatrists assuming people would need to take medication for life. The Commission found that people prefer to discuss their medication with the hospital pharmacists, and therefore it recommended that pharmacists play a greater role in schizophrenia care. A greater role for psychological care was also recommended, with CBT being rated in the Commission's survey as one of the most popular interventions alongside medication.
Professor Sir Murray outlined some of the Commission's recommendations, including viewing families as parties in care, offering continuity of care, addressing poor physical health which results in the early deaths of people with schizophrenia, and re-evaluating the high rates of coercion to ensure that secure provision is a necessary measure only for those who need it. A lively debate followed with members of the audience about differences in the care of schizophrenia between Australia and the United Kingdom, with insights from nurses, psychiatrists, psychologists and consumer consultants. The Schizophrenia Commission's full report, including 42 recommendations for better care, and its terms of reference can be viewed at The Schizophrenia Commission.