Category: Schizophrenia

Psychosis

On By KennethIn Bipolar, Delusions, Hallucinate, Psychosis, SchizophreniaLeave a comment

What is psychosis?

Psychosis is characterized by an impaired relationship with reality. It’s a symptom of serious mental disorders. People who are experiencing psychosis may have either hallucinations or delusions.

Hallucinations are sensory experiences that occur within the absence of an actual stimulus. For example, a person having an auditory hallucination may hear their mother yelling at them when their mother isn’t around. Or someone having a visual hallucination may see something, like a person in front of them, who isn’t actually there.

The person experiencing psychosis may also have thoughts that are contrary to actual evidence. These thoughts are known as delusions. Some people with psychosis may also experience loss of motivation and social withdrawal.

These experiences can be frightening. They may also cause people who are experiencing psychosis to hurt themselves or others. It’s important to see a doctor right away if you or someone you know is experiencing symptoms of psychosis.

Recognizing the symptoms of psychosis

Symptoms of psychosis include:

Suicide prevention

  1. If you think someone is at immediate risk of self-harm or hurting another person:
  2. • Call 999 or your local emergency number.
  3. • Stay with the person until help arrives.
  4. • Remove any guns, knives, medications, or other things that may cause harm.
  5. • Listen, but don’t judge, argue, threaten, or yell.
  6. If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline.

What are delusions and hallucinations?

Delusions and hallucinations are two very different symptoms that are both often experienced by people with psychosis. Delusions and hallucinations seem real to the person who is experiencing them.

Delusions

A delusion is a false belief or impression that is firmly held even though it’s contradicted by reality and what is commonly considered true. There are delusions of paranoia, grandiose delusions, and somatic delusions.

People who are experiencing a delusion of paranoia might think that they are being followed when they aren’t or that secret messages are being sent to them. Someone with a grandiose delusion will have an exaggerated sense of importance. Somatic delusion is when a person believes they have a terminal illness, but in reality they’re healthy.

Hallucinations

A hallucination is a sensory perception in the absence of outside stimuli. That means seeing, hearing, feeling, or smelling something that isn’t present. A person who is hallucinating might see things that don’t exist or hear people talking when they’re alone.

Causes of psychosis

Each case of psychosis is different, and the exact cause isn’t always clear. There are certain illnesses that cause psychosis, however. There are also triggers like drug use, lack of sleep, and other environmental factors. In addition, certain situations can lead to specific types of psychosis developing.

Illnesses

Illnesses that can cause psychosis include:

Some types of dementia may result in psychosis, such as that caused by:

Risk factors for developing psychosis

It’s not currently possible to precisely identify who is likely to develop psychosis. However, research has shown that genetics may play a role.

People are more likely to develop a psychotic disorder if they have a close family member, such as a parent or sibling, who has a psychotic disorder.

Children born with the genetic mutation known as 22q11.2 deletion syndrome are at risk for developing a psychotic disorder, especially schizophrenia.

Types of psychosis

Some kinds of psychosis are brought on by specific conditions or circumstances that include the following:

Brief psychotic disorder

Brief psychotic disorder, sometimes called brief reactive psychosis, can occur during periods of extreme personal stress like the death of a family member. Someone experiencing brief reactive psychosis will generally recover in a few days to a few weeks, depending on the source of the stress.

Drug- or alcohol-related psychosis

Psychosis can be triggered by the use of alcohol or drugs, including stimulants such as methamphetamine and cocaine. Hallucinogenic drugs like LSD often cause users to see things that aren’t really there, but this effect is temporary. Some prescription drugs like steroids and stimulants can also cause symptoms of psychosis.

People who have an addition to alcohol or certain drugs can experience psychotic symptoms if they suddenly stop drinking or taking those drugs.

Organic psychosis

A head injury or an illness or infection that affects the brain can cause symptoms of psychosis.

Psychotic disorders

Psychotic disorders can be triggered by stress, drug or alcohol use, injury, or illness. They can also appear on their own. The following types of disorders may have psychotic symptoms:

Bipolar disorder

When someone has bipolar disorder, their moods swing from very high to very low. When their mood is high and positive, they may have symptoms of psychosis. They may feel extremely good and believe they have special powers.

When their mood is depressed, the individual may have psychotic symptoms that make them feel angry, sad, or frightened. These symptoms include thinking someone is trying to harm them.

Delusional disorder

A person experiencing delusional disorder strongly believes in things that aren’t real.

Psychotic depression

This is major depression with psychotic symptoms.

Schizophrenia

Schizophrenia is a lifelong disease that is generally accompanied by psychotic symptoms.

How is psychosis diagnosed?

Psychosis is diagnosed through a psychiatric evaluation. That means a doctor will watch the person’s behavior and ask questions about what they’re experiencing. Medical tests and X-rays may be used to determine whether there is an underlying illness causing the symptoms.

Diagnosing psychosis in children and teenagers

Many of the symptoms of psychosis in adults aren’t symptoms of psychosis in young people. For example, small children often have imaginary friends with whom they talk. This just represents imaginative play, which is completely normal for children.

But if you’re worried about psychosis in a child or adolescent, describe their behavior to a doctor.

Treatment of psychosis

Treating psychosis may involve a combination of medications and therapy. Most people will experience an improvement in their symptoms with treatment.

Rapid tranquilization

Sometimes people experiencing psychosis can become agitated and be at risk of hurting themselves or others. In these cases, it may be necessary to calm them down quickly. This method is called rapid tranquilization. A doctor or emergency response personnel will administer a fast-acting injection or liquid medicine to quickly relax the patient.

Medication

Symptoms of psychosis can be controlled with medications called antipsychotics. They reduce hallucinations and delusions and help people think more clearly. The type of antipsychotic that is prescribed will depend on the symptoms.

In many cases, people only need to take antipsychotics for a short time to get their symptoms under control. People with schizophrenia may have to stay on medications for life.

Cognitive behavioral therapy

Cognitive behavioral therapy means meeting regularly to talk with a mental health counselor with the goal of changing thinking and behaviors. This approach has been shown to be effective in helping people make permanent changes and better manage their illness. It’s often most helpful for psychotic symptoms that don’t completely resolve with medications.

Complications and outlook of psychosis

Psychosis doesn’t have many medical complications. However, if left untreated, it can be challenging for people experiencing psychosis to take good care of themselves. That could cause other illnesses to go untreated.

Most people who experience psychosis will recover with proper treatment. Even in severe cases, medication and therapy can help.

Schizophrenia

On By KennethIn Care, Medication, Psychosis, Schizophrenia, TreatmentLeave a comment

Overview

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which causes significant distress for the individual, their family members, and friends. If left untreated, the symptoms of schizophrenia can be persistent and disabling. However, effective treatments are available. When delivered in a timely, coordinated, and sustained manner, treatment can help affected individuals to engage in school or work, achieve independence, and enjoy personal relationships.

Onset and Symptoms

Schizophrenia is typically diagnosed in the late teen years to the early thirties and tends to emerge earlier in males (late adolescence – early twenties) than females (early twenties – early thirties). A diagnosis of schizophrenia often follows the first episode of psychosis, when individuals first display symptoms of schizophrenia. Gradual changes in thinking, mood, and social functioning often begin before the first episode of psychosis, usually starting in mid-adolescence. Schizophrenia can occur in younger children, but it is rare for it to occur before late adolescence.

The symptoms of schizophrenia generally fall into the following three categories:

Psychotic symptoms include altered perceptions (e.g., changes in vision, hearing, smell, touch, and taste), abnormal thinking, and odd behaviors. People with psychotic symptoms may lose a shared sense of reality and experience themselves and the world in a distorted way. Specifically, individuals typically experience:

  • Hallucinations, such as hearing voices or seeing things that aren’t there
  • Delusions, which are firmly held beliefs not supported by objective facts (e.g., paranoia – irrational fears that others are “out to get you” or believing that the television, radio, or internet are broadcasting special messages that require some response)
  • Thought disorder, which includes unusual thinking or disorganized speech

Negative symptoms include loss of motivation, disinterest or lack of enjoyment in daily activities, social withdrawal, difficulty showing emotions, and difficulty functioning normally. Specifically, individuals typically have:

  • Reduced motivation and difficulty planning, beginning, and sustaining activities
  • Diminished feelings of pleasure in everyday life
  • “Flat affect,” or reduced expression of emotions via facial expression or voice tone
  • Reduced speaking

Cognitive symptoms include problems in attention, concentration, and memory. For some individuals, the cognitive symptoms of schizophrenia are subtle, but for others, they are more prominent and interfere with activities like following conversations, learning new things, or remembering appointments. Specifically, individuals typically experience:

  • Difficulty processing information to make decisions
  • Problems using information immediately after learning it
  • Trouble focusing or paying attention

Risk Factors

Several factors contribute to the risk of developing schizophrenia.

Genetics: Schizophrenia sometimes runs in families. However, it is important to know that just because someone in a family has schizophrenia, it does not mean that other members of the family will have it as well. Genetic studies strongly suggest that many different genes increase the risk of developing schizophrenia, but that no single gene causes the disorder by itself. It is not yet possible to use genetic information to predict who will develop schizophrenia.

Environment: Scientists think that interactions between genetic risk and aspects of an individual’s environment may play a role in the development of schizophrenia. Environmental factors that may be involved include living in poverty, stressful surroundings, and exposure to viruses or nutritional problems before birth.

Brain structure and function: Scientists think that differences in brain structure, function, and interactions among chemical messengers (called neurotransmitters) may contribute to the development of schizophrenia. For example, differences in the volumes of specific components of the brain, in the way regions of the brain are connected and work together, and in neurotransmitters, such as dopamine, are found in people with schizophrenia. Differences in brain connections and brain circuits seen in people with schizophrenia may begin developing before birth. Changes to the brain that occur during puberty may trigger psychotic episodes in people who are vulnerable due to genetics, environmental exposures, or the types of brain differences mentioned above.

Treatments and Therapies

The causes of schizophrenia are complex and are not fully understood, so current treatments focus on managing symptoms and solving problems related to day to day functioning. Treatments include:

Antipsychotic Medications

Antipsychotic medications can help reduce the intensity and frequency of psychotic symptoms. They are usually taken daily in pill or liquid forms. Some antipsychotic medications are given as injections once or twice a month, which some individuals find to be more convenient than daily oral doses. Patients whose symptoms do not improve with standard antipsychotic medication typically receive clozapine. People treated with clozapine must undergo routine blood testing to detect a potentially dangerous side effect that occurs in 1-2% of patients.

Many people taking antipsychotic medications have side effects such as weight gain, dry mouth, restlessness, and drowsiness when they start taking these medications. Some of these side effects subside over time, but others may persist, which may cause some people to consider stopping their antipsychotic medication. Suddenly stopping medication can be dangerous and it can make schizophrenia symptoms worse. People should not stop taking antipsychotic medication without talking to a health care provider first.

Shared decision making between doctors and patients is the recommended strategy for determining the best type of medication or medication combination and the right dose. You can find the latest information on warnings, patient medication guides, or newly approved medications on the U.S. Food and Drug Administration (FDA) website.

Psychosocial Treatments

Cognitive behavioral therapy, behavioral skills training, supported employment, and cognitive remediation interventions may help address the negative and cognitive symptoms of schizophrenia. A combination of these therapies and antipsychotic medication is common. Psychosocial treatments can be helpful for teaching and improving coping skills to address the everyday challenges of schizophrenia. They can help people pursue their life goals, such as attending school, working, or forming relationships. Individuals who participate in regular psychosocial treatment are less likely to relapse or be hospitalized. For more information on psychosocial treatments, see the Psychotherapies webpage on the NIMH website.

Family Education and Support

Educational programs for family members, significant others, and friends offer instruction about schizophrenia symptoms and treatments, and strategies for assisting the person with the illness. Increasing key supporters’ understanding of psychotic symptoms, treatment options, and the course of recovery can lessen their distress, bolster coping and empowerment, and strengthen their capacity to offer effective assistance. Family-based services may be provided on an individual basis or through multi-family workshops and support groups. For more information about family-based services in your area, you can visit the family education and support groups page on the National Alliance on Mental Illness website.

Coordinated Specialty Care

Coordinated specialty care (CSC) is a general term used to describe recovery-oriented treatment programs for people with first episode psychosis, an early stage of schizophrenia. A team of health professionals and specialists deliver CSC, which includes psychotherapy, medication management, case management, employment and education support, and family education and support. The person with early psychosis and the team work together to make treatment decisions, involving family members as much as possible. Compared to typical care for early psychosis, CSC is more effective at reducing symptoms, improving quality of life, and increasing involvement in work or school. Check here for more information about CSC programs.

Assertive Community Treatment

Assertive Community Treatment (ACT) is designed especially for individuals with schizophrenia who are at risk for repeated hospitalizations or homelessness. The key elements of ACT include a multidisciplinary team, including a medication prescriber, a shared caseload among team members, direct service provision by team members, a high frequency of patient contact, low patient to staff ratios, and outreach to patients in the community. ACT reduces hospitalizations and homelessness among individuals with schizophrenia. Check here for more information about ACT programs.

How can I help someone I know with schizophrenia?

Caring for and supporting a loved one with schizophrenia can be very challenging. It can be difficult to know how to respond to someone who is experiencing psychosis.

Here are some things you can do to help your loved one:

  • Help them get treatment and encourage them to stay in treatment
  • Remember that their beliefs or hallucinations seem very real to them
  • Tell them that you acknowledge that everyone has the right to see things their way
  • Be respectful, supportive, and kind without tolerating dangerous or inappropriate behavior
  • Check to see if there are any support groups in your area

Some symptoms require immediate emergency care. If your loved one is thinking about harming themselves or others or attempting suicide, seek help right away:

Finding Help

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the Behavioral Health Treatment Services Locator for finding mental health treatment facilities and programs. SAMHSA’s Early Serious Mental Illness Treatment Locator provides information about treatment facilities that offer coordinated specialty care. For additional resources, visit the NIMH Help for Mental Illnesses page.

Join a Study

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit directly from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge to help others in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your doctor about clinical trials, their benefits and risks, and whether one is right for you.

What Causes Schizophrenia?

On By KennethIn LSD, Marijuana, Methamphetamine, SchizophreniaLeave a comment

If you know someone with schizophrenia, you probably want to know why they have it. The truth is, doctors don’t know what causes this mental illness.

Research shows it takes a combination of genetics and your environment to trigger the disease. Knowing what increases the chances can help you put together a better picture of your odds of getting schizophrenia.

Is Schizophrenia Genetic?

Think of your genes as a blueprint for your body. If there’s a change to these instructions, it can sometimes increase your odds for developing diseases like schizophrenia.

Doctors don’t think there’s just one “schizophrenia gene.” Instead, they think it takes many genetic changes, or mutations, to raise your chances of having the mental illness.

They do know that you’re more likely to get schizophrenia if someone in your family has it. If it’s a parent, brother, or sister, your chances go up by 10%. If both your parents have it, you have a 40% chance of getting it.

What Are Your Chances of Getting Schizophrenia Genetically?

Your chances are greatest — 50% — if you have an identical twin with the disorder.

But some people with schizophrenia have no history of it in their family. Scientists think that in these cases, a gene may have changed and made the condition more likely.

Genetic Causes of Schizophrenia

Many genes play a role in your odds of getting schizophrenia. A change to any of them can do it. But usually it’s several small changes that add up and lead to a higher risk. Doctors aren’t sure how genetic changes lead to schizophrenia.

Environmental Triggers

Genetic changes can interact with things in your environment to boost your odds of getting schizophrenia. If you were exposed to certain viral infections before you were born, research suggests that your chances may go up. This could also be true if you didn’t get proper nutrition while your mother was pregnant with you, especially during her first 6 months of pregnancy. These are both theories, but they haven’t been proven by scientific studies.

Studies show that taking certain mind-altering drugs called psychoactive or psychotropic drugs, such as methamphetamine or LSD, can make you more likely to get schizophrenia. Some research has shown that marijuana use has a similar risk. The younger you start and the more often you use these drugs, the more likely you are to have symptoms like hallucinations, delusions, inappropriate emotions, and trouble thinking clearly.

The Role of Brain Chemistry and Structure in Schizophrenia

Scientists are looking at possible differences in brain structure and function in people with and people without schizophrenia. In people with schizophrenia, they found:

  • Spaces in the brain, called ventricles, were larger.
  • Parts of the brain that deal with memory, known as the medial temporal lobes, were smaller.
  • There were fewer connections between brain cells.

People with schizophrenia also tend to have differences in the brain chemicals called neurotransmitters. These control communication within the brain.

Studies of brain tissue in people with schizophrenia after death even show that their brain structure is often different than it was at birth.

Additional Risk Factors for Schizophrenia

  • An older father
  • Problems with your immune system, like inflammation or an autoimmune disease
  • Taking mind-altering drugs as a teen
  • Complications during pregnancy or birth such as:
    • Low birth weight
    • Premature labor
    • Exposure to toxins, bacteria, or viruses
    • Lack of oxygen during birth
  • Living in a low-income urban area

Schizophrenia

On By KennethIn Hallucinations, Irrational Thoughts, Recreational Drugs, Schizophrenia, Self Harm, Stress, Suicide1 Comment

Schizophrenia is a diagnosis given to some people who have severely disrupted beliefs and experiences.

During an episode of schizophrenia, a person’s understanding and interpretation of the outside world is disrupted – they may:

  • lose touch with reality
  • see or hear things that are not there
  • hold irrational or unfounded beliefs
  • appear to act strangely because they are responding to these delusions and hallucinations.

An episode of schizophrenia can last for several weeks and can be very frightening. About one in 100 people will have one episode of schizophrenia, and two thirds of these will go on to have further episodes. Schizophrenia usually starts in the late teens or early 20s, but can also affect older people for the first time.

The causes are unknown but episodes of schizophrenia appear to be associated with changes in some brain chemicals. Stressful experiences and some recreational drugs can also trigger an episode in vulnerable people.At least 26 million people are living with schizophrenia worldwide according to the World Health Organization, and many more are indirectly affected by it.

Symptoms

Doctors describe two groups of symptoms in people with schizophrenia: positive and negative. Although the positive symptoms are often the most dramatic and, at least initially, the most distressing, the negative ones tend to cause the most problems, as they tend to be longer lasting.

Positive symptoms

The three main positive symptoms are:

  • feelings of being controlled by outside forces (ie. having one’s thoughts and actions taken over)
  • hearing, seeing, smelling or feeling things which are not there (hallucinations)
  • irrational and unfounded beliefs (delusions).

The delusions can often be very frightening – the person may believe that others are plotting to kill them or that their conversations are being recorded. Positive symptoms all tend to occur during acute episodes and can be particularly frightening.

Negative symptoms

The negative symptoms include tiredness, loss of concentration, and lack of energy and motivation, which may be exacerbated by the side-effects of drugs used to treat the positive symptoms. Because of these symptoms, people with schizophrenia are often unable to cope with everyday tasks, such as work and household chores. Suicide and self-harm are common in people with a diagnosis of schizophrenia: around one in 10 take their own life.

Misconceptions about schizophrenia

There is more media misinformation about schizophrenia than about any other type of mental health problem. A diagnosis of schizophrenia does not mean ‘split personality’, or indicate that someone will be calm one minute and then be ‘out of control’ the next. 

Sensational stories in the media tend to present people with schizophrenia as dangerous, even though most people diagnosed with schizophrenia don’t commit violent crimes. Another misconception is that people who hear voices are dangerous, but actually voices are more likely to suggest that you harm yourself than someone else and people have a choice in whether they do what the voices say.

Treatments

Most people with schizophrenia are prescribed drugs to reduce the positive symptoms. The drugs may be prescribed for long periods and may have unpleasant side effects.

Some people need a great deal of help in managing the symptoms of schizophrenia. Others find ways to cope with experiences such as hearing voices and do not necessarily wish to receive any treatment.

Sometimes, people in an acute phase of the illness may need to be admitted to hospital under the Mental Health Act for their own, or other people’s, safety. People with schizophrenia are not usually dangerous to other people; they are more at risk of harm from others, or themselves.

Many people who are at risk of relapse carry Crisis Cards or have written up Advance Directives stating how they would like to be treated and what they do and do not find helpful. Mental health professionals do not have to follow these instructions, but it is considered good practice to take the person’s wishes into account.

Getting help

If you, or someone you care for, are experiencing the symptoms of schizophrenia you may wish to contact your GP who can prescribe drug treatments and refer you for psychiatric help. You may also be referred to social services and the local community mental health team who can support you at home.

If you need urgent support or you feel like harming or hurting yourself or anyone else, call 999 or go to the nearest hospital accident and emergency department.

If your need is less urgent, you can contact the NHS Direct helpline on 111, which is open 24 hours a day, 365 days a year. They can also provide information about your nearest A&E and other support services.

A major health inequality is that people with a diagnosis of schizophrenia die, on average, 20 years younger than the general population – this is unacceptable. Poor physical health can arise as a side effect of anti-psychotic medication – for example through weight gain and increased risk of developing diabetes. Poor physical health can also result because of a failure to monitor risk factors. We want GPs to carry out regular health checks for all people with severe mental health problems. 

Self-management of schizophrenia

Through self-management, many service users gain confidence, skills and knowledge to better manage their mental health and gain more control of their lives at a time when they may feel they have lost control. The Foundation is developing, delivering and evaluating a range of self-management interventions for people with severe psychiatric diagnoses in Wales including schizophrenia.

Schizophrenia

On By KennethIn Mental Health, Schizophrenia, Symptoms1 Comment

Key facts

  • Schizophrenia is a chronic and severe mental disorder affecting 20 million people worldwide (1).
  • Schizophrenia is characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common experiences include hallucinations (hearing voices or seeing things that are not there) and delusions (fixed, false beliefs).
  • Worldwide, schizophrenia is associated with considerable disability and may affect educational and occupational performance.
  • People with schizophrenia are 2-3 times more likely to die early than the general population (2). This is often due to preventable physical diseases, such as cardiovascular disease, metabolic disease and infections.
  • Stigma, discrimination and violation of human rights of people with schizophrenia is common.
  • Schizophrenia is treatable. Treatment with medicines and psychosocial support is effective.
  • Facilitation of assisted living, supported housing and supported employment are effective management strategies for people with schizophrenia.

Symptoms

Schizophrenia is a psychosis, a type of mental illness characterized by distortions in thinking, perception, emotions, language, sense of self and behaviour. Common experiences include:

  • hallucination: hearing, seeing or feeling things that are not there;
  • delusion: fixed false beliefs or suspicions not shared by others in the person’s culture and that are firmly held even when there is evidence to the contrary;
  • abnormal behaviour: disorganised behaviour such as wandering aimlessly, mumbling or laughing to self, strange appearance, self-neglect or appearing unkempt;
  • disorganised speech: incoherent or irrelevant speech; and/or
  • disturbances of emotions: marked apathy or disconnect between reported emotion and what is observed such as facial expression or body language.

Magnitude and impact

Schizophrenia affects 20 million people worldwide but is not as common as many other mental disorders. Schizophrenia also commonly starts earlier among men.

Schizophrenia is associated with considerable disability and may affect educational and occupational performance.

People with schizophrenia are 2 – 3 times more likely to die early than the general population (2). This is often due to physical illnesses, such as cardiovascular, metabolic and infectious diseases.

Stigma, discrimination and violation of human rights of people with schizophrenia is common.

Causes of schizophrenia

Research has not identified one single factor. It is thought that an interaction between genes and a range of environmental factors may cause schizophrenia.

Psychosocial factors may also contribute to schizophrenia.

Services

More than 69% of people with schizophrenia are not receiving appropriate care (3). Ninety per cent of people with untreated schizophrenia live in low- and middle- income countries. Lack of access to mental health services is an important issue. Furthermore, people with schizophrenia are less likely to seek care than the general population.

Management

Schizophrenia is treatable. Treatment with medicines and psychosocial support is effective. However, most people with chronic schizophrenia lack access to treatment.

There is clear evidence that old-style mental hospitals are not effective in providing the treatment that people with mental disorders need and violate basic human rights of persons with mental disorders. Efforts to transfer care from mental health institutions to the community need to be expanded and accelerated. The engagement of family members and the wider community in providing support is very important.

Programmes in several low- and middle- income countries (e.g. Ethiopia, Guinea-Bissau, India, Iran, Pakistan and United Republic of Tanzania) have demonstrated the feasibility of providing care to people with severe mental illness through the primary health-care system by:

  • training primary health-care personnel;
  • providing access to essential drugs;
  • supporting families in providing home care;
  • educating the public to decrease stigma and discrimination;
  • enhancing independent living skills through recovery-oriented psychosocial interventions (e.g. life skills training, social skills training) for people with schizophrenia and for their families and/or caregivers; and
  • facilitating independent living, if possible, or assisted living, supported housing and supported employment for people with schizophrenia. This can act as a base for people with schizophrenia to achieve recovery goals. People affected by schizophrenia often face difficulty in obtaining or retaining normal employment or housing opportunities.

Human rights violations

People with schizophrenia are prone to human rights violations both inside mental health institutions and in communities. Stigma of the disorder is high. This contributes to discrimination, which can in turn limit access to general health care, education, housing and employment.

WHO response

WHO’s Mental Health Gap Action Programme (mhGAP), launched in 2008, uses evidence-based technical guidance, tools and training packages to expand service in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care. Currently mhGAP is being implemented in more than 100 WHO Member States.

The WHO QualityRights Project involves improving the quality of care and human rights conditions in mental health and social care facilities and to empower organizations to advocate for the health of people with mental disorders.WHO’s Mental Health Action Plan 2013-2020, endorsed by the World Health Assembly in 2013, highlights the steps required to provide appropriate services for people with mental disorders including schizophrenia. A key recommendation of the Action Plan is to shift services from institutions to the community.