Sir, The article, "Schizophrenia in the Family", (April 29th) has provoked a big reaction from many members of the Schizophrenia Association of Ireland. Some people have been reminded about their own experiences with the illness and their efforts to have the family included as an integral part of the care and treatment for their relative. Others have been distressed at the language used in the article, and despaired at another story which seems to demonise people with a mental illness, using animal imagery to depict the person and the illness. We empathise with the plight of the family in this story, including the ill person, who have battled with the serious effects of this illness.
Schizophrenia is the most disabling mental illness which directly affects approximately 35,000 people in this country. The illness affects people in different ways, and people respond in different ways to different drugs. However, there are issues of common interest to everybody. More research is now being done on the role of the family in the care of people with mental illness, and the role of psychosocial education and rehabilitation for both the person with the illness and the primary carers, (usually families).
All of the research studies in this area have shown that there are great benefits to be gained by educating everyone concerned on all aspects of the illness, including its manifestations, medication, side effects of medication, coping skills, and stress management. In addition, it has been shown that including the person with the illness and their family in all aspects of the care plan, particularly discharge planning, has benefits at all levels. While outcome measurement can be very subjective, and the various interest groups will prioritise different outcomes, it is crucial to understand that this type of appropriate care and treatment has clinical, social, family and economic benefits.
There is a greater ability for people with schizophrenia and their carers to understand and cope with the illness, which favourably affects their quality of life. Liz Kuipers, a London psychiatrist, has worked on this area for several years, and her research shows that relapse rates are greatly reduced by educating all concerned, including the family at all levels of care, and helping them cope with the illness. Increasing the ability to cope and helping people manage their stress reduces relapse rates. This is also good news for the economists as it reduces hospital bed days, which it is accepted are an expensive part of treatment. Society benefits by people with schizophrenia being able to integrate more fully into our community, achieve their potential and become productive members of our society within the limits of their disability.
The Schizophrenia Association of Ireland advocates that people with schizophrenia and their carers are used as a resource in the treatment of the illness. Many people with schizophrenia have a very good insight into their illness, and they should be included as part of the care team when their treatment plan is being formulated. This also goes for families, most of whom will have day today interaction with their relative, and who will have first hand knowledge of the health of the individual, including whether they are responding well to a particular drug, or whether they are showing signs of relapse.
Another area of the illness which is being looked at by many researchers worldwide is that of first episode psychosis and early intervention. Research is showing, that correct and appropriate care in the initial stages of the illness can have a very beneficial effect. This factor should be of great interest to everyone it means that we will provide proper care in the negative effects of the illness on the individual, which will have consequences for later medical care requirements. This is an issue which should be looked at closely by all care providers, including the private health insurers. Recent legislation has set minimum cover for in hospital care well below current levels offered by VHI. The likely outcome is that this minimum will become effective maximum cover. However, given current research outcomes, this will not necessarily be the most cost effective option for private health insurers. It remains to be seen whether BUPA will be taking a long term approach to this issue. It goes without saying that this also applies to our public system. At the very least, discharging people before they are well is not cost effective, but of course this would also have negative family, social, and clinical impacts.
The Schizophrenia Association of Ireland provides invaluable information and support to all those who are affected by the illness. There are support groups through out the country and we also train families in coping skills. The association also represents people with the illness and their carers at all levels in our society. One of our major objectives is to promote a greater understanding and awareness of the illness. The effects of stigma are extremely negative on the health, employment prospects and quality of life of the person with the illness and their families it is an effect which we can all do something about.
Yours, etc.. Administrator, Schizophrenia Association of Ireland, Fitzwilliam Place, Dublin 2.