This year’s theme for World Mental Health Day, “living with schizophrenia,” is a valuable message for those of us who treat patients with the illness and for the patients themselves.
After all, about 25% of people with schizophrenia reportedly recover fully, and 25%-35% improve considerably. This means that with effective treatment and interventions, up to 50% of people with schizophrenia can live productive and satisfying lives (Schizophr. Bull 2006;32:432-42).
Dr. Amin A. Muhammad Gadit
The medications, awareness, and research needed to make schizophrenia a manageable disease must be combined with a supportive network for the patient. In addition, compliance in terms of strict adherence to medications is needed to keep the illness at bay, as are employment, nutrition, physical well-being, and avoidance of substance abuse.
Authors of the World Federation for Mental Health’s report on World Mental Health Day 2014 cited two examples of the kinds of services that can help patients with schizophrenia lead productive lives. Fountain House, a professional self-help program based in New York, assists people living with mental illness with securing jobs, schooling, housing, and wellness. Some suggest that these kinds of recovery centers might be an “emerging best practice” (Psychiatric Serv. 2012 [doi:10.1176/appi.ps.201200p10]).
The other example of a model cited by the authors describes the chain-free initiative in Mogadishu, Somalia. This model includes three phases. In phase 1, chains are literally removed from patients; in phase 2, professionals visit patients at home and provide family psychosocial education; and in phase 3, the focus is on “removing the ‘invisible chains’ of stigma and restrictions affecting the human rights of persons with mental illness.” Thanks to this initiative, more former patients reportedly are living in the community, and the community has greater awareness about the rights of people with severe mental illness.
Reducing stigma is critical, as this factor has the capacity to determine the prognosis of schizophrenia. Let’s toss out terms describing people with schizophrenia such as “crazy,” “dangerous,” “not manageable at home,” “unemployable,” and “unable to function in society.”
In 2012, the 5th Geneva Conference on Person-Centered Medicine made several recommendations that incorporate many of the principles promoted by Fountain House and the chain-free initiative. They include integrating health promotion and illness prevention; engaging health services in prevention, diagnosis, and treatment of diseases through multidisciplinary approaches; collaborating closely on clinical care and public health; engaging civil society in such efforts.
Health care workers across the globe face big challenges when it comes to managing schizophrenia. Those of us practicing medicine in developing and developed countries must educate, raise awareness, and mobilize resources in the fight against the illness.
Schizophrenia remains a major global mental health problem, but living with the illness has become possible. Perhaps 10 to 20 years down the road, we will be closer to identifying a cause, and this discovery, in turn, might lead to new horizons for treatment.
Dr. Gadit is a professor of psychiatry at the University of Toronto.