The Abandoned Illness – the Schizophrenia Commission’s Report



The Schizophrenia Commission published their report on Schizophrenia and psychosis yesterday (14^th November 2012). You can find the full report here.

 

It's a pretty scathing report. It lays bare the devastating effects on individuals experiencing this illness in the social, health and economic spheres. It finds that “people with severe mental illness such as schizophrenia still die 15-20 years earlier than other citizens”. It notes that “only 8% of people with schizophrenia are in employment”. Despite schizophrenia and psychosis costing society £11.8 billion a year the commission found “a broken and demoralised system that does not deliver the quality of treatment that is needed for people to recover.”  The report notes that “mental illness accounts for 23% of the disease burden in England, but gets only 13% of NHS resources.”

 

None of this comes as a surprise to professionals working in the mental health field. The report comes at a time when many mental health trusts are having to “reconfigure” services (a euphemism for devastating cuts in staff and resources, which have been necessary because of the year on year reductions in the budgets being doled out by central government.). One of the innovations the report praises are the creation of early intervention teams, specialist teams who focus on treating emerging psychosis at the earliest signs – but at the same time it observes that these same teams are being cut back in these trust “reconfigurations”.

 

The report also expresses concern about the increasing numbers of people treated under section, “partly because they delay seeking help until they are at crisis point. Levels of coercion are on the increase too, with a 5% increase in detentions under the Mental Health Act in 2010/2011 over the previous year.” (And it’s not getting better -- for the year 2011-12 there was a 6% increase.)

 

It notes too that “too much is spent on secure care – £1.2 billion or 19% of the mental health budget last year – with many people staying too long in expensive units when they are well enough to start back on the route to the community”. These people will be of course inevitably be detained under various sections of the MHA.

 

The commission unfortunately sees current and future changes in legislation continuing to adversely affect the prospects of people with serious mental illness. I have written here and elsewhere about my concerns about the suitability of the Work Capability Assessment when applied to people with mental illness. The commission makes it very clear that it is “not fit for purpose for people affected by mental illness and is in need of reform. The design of the assessment does not accurately identify the barriers they face in a working environment. There is also a low level of mental health expertise amongst assessors. Schizophrenia and psychosis can make it more difficult to complete the application and assessment process. Sadly, therefore, some of the most vulnerable claimants are potentially being excluded from the support they are entitled to.”

 

I wrote in the Guardian some months ago about my own experiences of accompanying people to these assessments, where it was quite apparent that the assessors often had no knowledge or understanding of mental illness. I found myself having to explain that paroxetine was an antidepressant, and the assessor only showed any interest in the assessment when the service user mentioned that he had a bad back – within seconds they had him on an examination table, manipulating his spine to see if he was experiencing any pain. But this was not the disabling condition.

 

The commission recommends “that the Work Capability Assessment process is amended for people with schizophrenia and psychosis to require the Department for Work and Pensions to seek information from health professionals to guide decisions rather than requiring potentially vulnerable people to navigate complex systems in order to provide it. The same principle should be built into plans relating to any qualifying assessment for the new Personal Independence Payment.”

 

Other changes affecting people with schizophrenia include the changes to eligibility criteria for personal budgets (the system whereby local authorities provide people with disabilities with money to help them with the problems they encounter in their lives in relation to their disability). To counter inconsistencies in the way this is administered, the Government is currently setting a national eligibility threshold through the Care and Support Bill regulations. The report expresses concern “that the social care eligibility threshold will be increased so that people with schizophrenia who are deemed to have ‘moderate’ needs (often due to their condition fluctuating) will lose support. Without this, a person’s mental health condition may deteriorate, resulting in a crisis and requiring access to more costly health or social care interventions, and possibly use of compulsory powers of the Mental Health Act.

 

The report makes many recommendations, designed to counter and resolve the indentified problems. The report is hopeful “that outcomes can be improved for everyone affected by severe mental illness. But it will require a radical overhaul of the system including an integrated approach with health and social services working together, a greater emphasis on patient preferences and a widespread application of flexible and innovative solutions. We do know what works – let’s apply it.”

 

I’d like to feel as optimistic as the Schizophrenia Commission appears to be, but I fear that “knowing what works” is not sufficient, when evidence based policy seems to be being replaced by political dogma.