Inquiry highlights “catastrophic failings” in treatment of people with schizophrenia and psychosis in England

An independent inquiry into the state of care for people with schizophrenia and psychosis in England is calling for a widespread overhaul of the system.

It says too much is being spent on the most expensive form of care, secure care, and more should be invested in prevention and community support.

The Schizophrenia Commission, established in 2011 by English charity Rethink Mental Illness, says care of people with schizophrenia and psychosis in England is falling “catastrophically short”. It says improvements in the understanding and treatment of the condition mean it should no longer be considered a “diagnosis of despair”.

Their report, “An Abandoned Illness”, describes “shameful” standards of care on some acute mental health wards, which can “make patients worse rather than better”. It calls for every ward in England to be brought to a standard where people would recommend them to a friend or relative.

The report also highlights the disparity between the money spent on people with physical illness and those with mental illness; only 13% of the NHS budget goes towards treating mental ill health, even though 23% of conditions dealt with by the NHS are mental rather than physical. It also expresses concerns that highly effective early intervention treatment teams are being cut in some areas; these are estimated to save the NHS £16,000 per person over the first three years of their illness.

Professor Sir Robin Murray, chair of the commission said: “We have spent the last year listening to expert professionals and more importantly, the experiences of people who have schizophrenia and psychosis and their families.

“The message that comes through loud and clear is that people are being badly let down by the system in every area of their lives. People with psychosis need to be given the hope that it is perfectly possible to live a fulfilling life after diagnosis. We have no doubt that this is achievable.”

Paul Jenkins, CEO of the charity Rethink Mental Illness, who sat on the commission said: “It’s been over 100 years since the term “schizophrenia” was first coined, but care and treatment are still nowhere near good enough. It is a scandal that in 2012 people with schizophrenia are dying 15-20 years earlier than the general population and that only 7% are able to get a job. Too many people are falling through the gaps in the system and ending up in prison or homeless.”

Commenting on the report Bill Walden-Jones, Chief Executive of Welsh mental health charity Hafal, said: “Sadly there’s no reason to suppose that the experiences of people with schizophrenia and psychosis in Wales are any better than the experiences of those in England. Indeed in some respects the re-development of the in-patient estate in Wales lags behind England. This excellent report is a reality check.

“We now have good legislation in Wales and a sound Mental Health Strategy but the truth is that there remains a huge amount of work to do to put right the shameful injustice of how people with a serious mental illness have been treated. Above all this report tells us that the priority is to devote additional resources and effort into providing a decent service to people with the very highest needs.”

Key evidence submitted to the commission included:

  • People with schizophrenia are dying 15-20 years earlier than average, mostly due to preventable, physical conditions.
  • Only 10% of people with schizophrenia are being offered potentially life-transforming talking therapies such as CBT.
  • Mental health hospital wards are often such appalling places they make patients worse rather than better.
  • 1 in 3 people affected say they can’t get quick access to services when they need it – and many don’t know where to go for help.
  • Major concerns remain about the lack of efficacy and side effects of anti-psychotic drugs, which can lead to rapid weight gain, diabetes, and heart disease.
  • Very few get the level of care that the health watchdog NICE says they should, despite that fact that treatments are available which work better and cost less.
  • Staff are often demoralized and “burnt out” and pessimism pervades the system

Key recommendations include:

  • A complete overhaul of inpatient units including more widespread use of community based “recovery houses”.
  • A redirection of funding from secure units into early intervention services, which save the taxpayer money and prevent people reaching crisis point.
  • More research on the causes and treatment of schizophrenia and psychosis including the development of better drugs with fewer side effects.
  • The elimination of poor prescribing by psychiatrists and the right to a second opinion on medication for patients.
  • Extending access to psychological therapies and assertive physical health interventions starting on the inpatient ward.
  • A stronger focus on prevention, including clear warnings about the risks of cannabis.
  • Greater partnership with people with psychosis – valuing their experiences and making their preferences and goals central to their recovery.
  • Action to meet the needs of all marginalised groups, and especially those from African and Caribbean communities.
  • A better deal for long-term carers who should be treated as partners, not problems.

To read the report please go to: