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Schizophrenia and the Mental Health System

Schizophrenia and the Mental Health System

What is Schizophrenia

  • Schizophrenia is a serious, treatable brain disease that drastically affects behaviour. In its acute stages, it deprives a person of contact with reality.
  • Common symptoms include thought disorders, delusions, hallucinations (seeing or hearing things that do not exist), hostility and extreme suspiciousness or paranoia, social and emotional withdrawal, lack of motivation, difficulty in abstract thinking and depression.
  • The exact cause of schizophrenia is not known. Two neurotransmitters in the brain are believed to be involved in the development of schizophrenia. Genetic and environmental factors are also believed to be linked with development of schizophrenia.

Who is Affected by Schizophrenia

  • 1 in 100 people will develop schizophrenia in their lifetime. In Ontario that is over 140,000 people.
  • Schizophrenia strikes men and women equally, and people of all racial, ethnic, class and economic backgrounds.
  • Schizophrenia generally strikes young people in the prime of their lives, in their late teens and early adult years.
  • Families are greatly disrupted by schizophrenia. Families are usually the primary care providers of people with schizophrenia. They must cope with the unpredictability of the individual affected, the side effects of medication, and with the frustration and worry about their loved one’s future.

Economic Costs

  • Direct and indirect costs of schizophrenia in Canada are approximately $6.85 billion annually.1
  • It is estimated that less than 20% of people with schizophrenia are employed in the competitive market place.2
  • Social assistance programs (Ontario Disability Support Program and Ontario Works) are the main source of income for people with schizophrenia.

Social Costs

 Schizophrenia has a profound impact on a person’s development and ability to function in all aspects of life including self-care, family and social relationships, education, employment and housing:
  • Schizophrenia is ranked the third most disabling condition in the world.
  • Most people with schizophrenia cannot secure and maintain regular full-time employment.
  • 60% to 70% of people with schizophrenia do not marry or partner.3
  • Approximately 60% of people with schizophrenia live with their families4 and most have difficulties socializing.
  • People with schizophrenia are over represented among the poor, homeless and prison populations.
  • Between 30% and 35% of homeless people and 75% of homeless single women in Toronto have a mental illness.5
  • Substance use/abuse is common among people with schizophrenia. Up to 80% of people with schizophrenia will abuse substances in their lifetime.6
  • Suicide is the leading cause of premature death among people with schizophrenia. 10% will die from suicide.

Treatment of Schizophrenia

  • Hospital and community based mental health services are both essential for treatment and support of people with schizophrenia. The episodic and cyclical nature of schizophrenia means acute psychiatric services, including hospital stays will always be needed. Although most mental health care is provided outside of hospitals, hospitalization is important for people who remain chronically mentally ill despite treatment advances.
  • Comprehensive, effective treatment includes a combination of anti-psychotic medication, counseling or therapy, hospitalization if required, family and community education and support, and psycho-social supports such as housing and employment support, recreation and education.
  • Early diagnosis, intervention and treatment are vital for improving chances of recovery and limiting long-term damage resulting from schizophrenia.
  • Anti-psychotic medication is the cornerstone of treatment for schizophrenia. Unrestricted access to anti-psychotic medications through both private and public drug plans is essential in the treatment of schizophrenia.

Access to Treatment

  • People with schizophrenia occupy 1 in 12 hospital beds in Canada. 7 This is the greatest number of beds occupied by a specific condition. Despite this, many families affected by schizophrenia experience difficulties securing treatment for their family members with schizophrenia. Shortages of acute care hospital beds, mental health laws which make it difficult to necessitate treatment, premature discharge and misdiagnosis are barriers to treatment.
  • The average length of stay in hospital for schizophrenia is decreasing. The length of stay dropped from 38 days per year in 1995 to 27 days per year in 1999.8
  • People who are chronically and severely mentally ill often remain symptomatic after discharge from hospital and would continue to benefit from hospitalization.
  • Hospital discharge planning could be improved to avoid discharge without family consultation or plans for essential follow-up services by the hospital or other services. Clinicians discharge approximately three of four patients back to their families.9
  • Studies show that when community mental health programs such as ACT teams and case management are in place, they reduce hospitalizations, emergency room visits and crisis. ACT programs have been shown to reduce hospitalization.
  • Bill 68, also known as Brian’s Law, was passed in 2000 making provisions for Community Treatment Orders (CTOs). CTOs are contracts issued by physicians that define treatment programs or the conditions under which someone with a mental illness may live in the community.
  • CTOs can only be issued for people with a prior psychiatric history. They do not assist families in securing treatment or care for their loved ones for the first time.

Violence and Mental Illness

There is a tendency in the media and among the public to associate violence with mental illness. The majority of people who are violent do not suffer from mental illnesses and most people with schizophrenia do not hurt anyone. In fact they are more at risk of self-harm than of perpetrating violence. 10
 
What we know
  • People with schizophrenia are not violent because of mental illness: there can be so many other factors at play that can influence a violent outcome, such as a past history of violence (regardless of having a mental illness or not), substance use, and failure to take medication. 11
  • When people with mental illness do exhibit violent behaviour, it is usually not directed at the general public; the most common targets of violence are family members with the behaviours being seen in the home, not in public. 14
  • In the rare cases where violent acts are committed by someone with serious mental illness such as schizophrenia, the individuals responsible are often found to be in need of medication. Violence, then, is often a treatment issue and individuals with severe mental illness need access to the right treatment and community support. Mental health laws which necessitate treatment before an individual demonstrates risk to oneself or others are required.
  • A subset of people with schizophrenia and other psychotic disorders may be violent if their paranoid delusions and other symptoms are not treated, especially if they are abusing alcohol or drugs. However, numerous studies show that when symptoms are treated, the risk of violence is very low. 12
  • In most cases where violent acts are committed, the individuals responsible are found not to be taking their medication. Violence, then is a treatment issue and individuals with severe mental illness need access to treatment. Mental health laws which necessitate treatment before an individual demonstrates risk to oneself or others are required. 13

How we talk about violence and mental illness matters

The language we use to talk about mental illness, mental health and violence matters and can impact not only public perception but propagate stigma, misunderstanding, and social exclusion for those living with mental illness. Derogatory terms such as “crazy,” “insane,” “psychotic,” etc., are just some examples of insensitive, hurtful terminology that should at all costs be avoided in respectful, constructive conversation.

According to the Canadian Mental Health Association (CMHA), “the fear that people with mental health conditions may be dangerous or violent is at the core of the stigma, discrimination and social exclusion experienced by individuals with mental health conditions. Research on public perceptions and attitudes about mental health have identified stereotypes that people with a mental illness pose a threat to public safety. Indeed, a 2008 study found that one in four Canadians admitted they would be fearful to be around someone with a serious mental illness. Existing research indicates that these fears are misplaced.” 15

The term “mental illness” is also misleading because it suggests a permanent state. In many cases, symptoms of acute mental illnesses are brief and often surrounded by periods where the person is well (in recovery). Thus, a person can experience mental well-being in spite of a diagnosis of a mental illness.15

For more information: Violence and Mental Health, Canadian Mental Health Association

We cannot stress enough the importance of early intervention (i.e. getting diagnosed and treated when the symptoms first start or when they recur) as well as appropriate treatment and support for people impacted by serious mental illness like schizophrenia and psychosis, because even in the cases of schizophrenia where there is that very tiny percentage of people with schizophrenia that do have a dangerous or violent outcome, it’s almost always because they are uncared for or are untreated on under-treated, and are left to cope on their own with an illness that isn’t being maintained or managed well.
 

Criminalization of People with Mental Illness

  • Research shows that when appropriate services such as case management and supportive housing are available, the number of crises requiring immediate intervention, including intervention by police, significantly decreases. Hospitalizations are reduced by up to 86%.15
  • Without inadequate treatment options available, the police and criminal justice sector are currently handling more and more people with severe mental illness.
  • The Ontario Association of Chiefs of Police recognizes that vulnerable people are having greater contact with the police and criminal justice system due to the inadequate funding of community mental health services.16 Between 1998 and 2001, uniformed police in London doubled the time they spent dealing with people with serious mental illness from 5,000 to over 10,000 hours per year .17
Impact of Schizophrenia and Psychosis (Infographic)

 


1 Goeree, R., et. cal. (2005). The Economic Burden of Schizophrenia in Canada in 2004, Curr Med Res Opin. 21(12):2017-2028.
2 Lauriello, J. et. al. (1999). A Critical Review of Research on Psycho-social Treatment of Schizophrenia, Society of Biological Psychiatry. Vol. 46, pp. 1409-1417.
3 Health Canada. A Report on Mental Illnesses in Canada. Ottawa, Canada 2002.
4 Seeman, M. (1998). The Family and Schizophrenia, Human Medicine, 4(2) pp. 96-100
5 Mayor’s Homelessness Action Task Force (1999). Taking Responsibility for Homelessness: An Action Plan for Toronto.
6 Health Canada. A Report on Mental Illnesses in Canada. Ottawa, Canada 2002.
7 In Line, E. (no date). An Introduction to Early Psychosis Intervention. Canadian Mental Health Association.
8 Health Canada. A Report on Mental Illnesses in Canada. Ottawa, Canada 2002.
9 In Canadian Mental Health Association, Ontario Division. Fact Sheet 3 – Who provides mental health care in Ontario.
10 Canadian Mental Health Association (2003). Violence and Mental Illness. Fact Sheet available at http://www.ontario.cmha.ca/content/reading_room/factsheets.asp
11 Torrey, Fuller (2006). Violence and Schizophrenia. Available at http://www.psychlaws.org/GeneralResources/110006SchizophreniaResearch.htm
12 Ibid.
13 Ibid.
14 Canadian Mental Health Association (2003). Violence and Mental Illness. Fact Sheet available at http://www.ontario.cmha.ca/content/reading_room/factsheets.asp
15 https://ontario.cmha.ca/documents/violence-and-mental-health-unpacking-a-complex-issue/
16 http://www.oacp.on.ca/resolutions/view.html?ID=52 17 http://www.oacp.on.ca/PresentationDonnerStudy.pdf