Warning over schizophrenics

Not all schizophrenics can live in the community

Some schizophrenics are unable to live in the community and must be cared for in hospital, a leading psychiatrist has warned.

Dr Steve Brown, a consultant psychiatrist at the Royal Southampton Hospital, said family breakdown and a deterioration in their condition means some patients with schizophrenia have to be cared for in hospital.

The number of psychiatric beds in the NHS have been significantly reduced over the past 40 years, in line with policies to encourage more people with a mental illness to live in the community.

But Dr Brown has warned that these policies must also include plans to care for some patients in hospital when they can no longer live in the community.

I think those who provide services need to recognise that a proportion of family care arrangements will just break down

Dr Steve Brown, Royal Southampton Hospital

Dr Brown carried out a study of 180 people who were diagnosed with schizophrenia 15 years ago. The aim of the study was to see how they were coping over the long term.

It found that one in four of these people were living in institutional care having spent time living with their families or alone in the community.

Their transfer to hospital was down to a number of factors, including the deaths of parents, breakdown of families and a deterioration in their condition.

"In some of these cases, this was because the individuals were too ill or because their parents had died or were too frail to look after them," Dr Brown told BBC News Online.

"Half of those we studied were still living with their families and the remainder were living by themselves in the community."

Diagnosed

The study also found that the overall condition of many of the patients had remained unchanged 15 years after they had been originally diagnosed.

"We found very little change in the level of disturbed behaviour compared to 15 years ago when these people were first assessed.

"Some people who had been ill 15 years ago were now settled while some people who had been settled were now ill.

Hospitals cannot provide an acceptable long-term solution

Cliff Prior, NSF

"These people have got a level of chronic disability. Quite a lot can be achieved with drug treatments but most are left with a chronic disability which families have to cope with and work around."

The study also found that varying levels of support from social services meant some families were finding it difficult to cope.

"There were very variable levels of support. The general view amongst families was that it had taken a long time to get the support they needed.

"It was only after a number of years that they felt they were getting the right support. We found clear evidence that families were suffering hardship.

"Some parents couldn't go to work because they felt they had to keep an eye on their son or daughter. Others felt they couldn't even go out for an evening."

Dr Brown said the study showed a need for the option of hospital care to be kept open for some people.

"I think those who provide services need to recognise that a proportion of family care arrangements will just break down, for one reason or another.

"Patients are going to need alternative care. I think this study underlines the need for suitable accommodation to be planed for those who are cared for in the community."

However, he added that the study did not uncover any individuals with schizophrenia who were living in the community but needed hospital care.

Long-term solutions

But Cliff Prior, chief executive of the National Schizophrenia Fellowship said improved policies could help patients with the condition to continue to live in the community.

"Hospitals cannot provide an acceptable long-term solution on those occasions when family support breaks down in the community.

"In the first instance, social services and the NHS need to recognise the work of informal carers with practical support packages.

"They also need to take up the challenge of creating a range of supported accommodation in the community so that people with severe mental illness can recover the best quality of life possible."

Dr Brown presented his findings to Caring for Carers, a conference organised by the National Schizophrenia Fellowship in Bristol on Thursday.