Schizophrenia Policy Report: A Call for Change
APNA Representative  Mary Moller

Earlier this year APNA Respresentative Mary Moller, DNP, ARNP, APRN, PMHCNS-BC, CPRP, FAAN joined an international group of experts for a think tank on schizophrenia policy. The resultant document, Schizophrenia: Time to Commit to Policy Change, was endorsed by APNA and published on October 10th in honor of World Mental Health Day. It calls for a more integrated and recovery-based approach towards the care of persons living with schizophrenia.

Chair of the policy group, Professor Wolfgang Fleischhacker of the Medical University Innsbruck in Austria explains,  “We conducted a number of in-depth discussions among all those involved in the management of people living with schizophrenia, and it became increasingly evident that there was a lack of provision of integrated care. As there is sound scientific evidence that such interventions are very effective, the key recommendation of our report is that policy frameworks need to be put in place at both national and local levels to ensure that a more integrated approach is taken."

On November 5th, the report will be presented and debated at the meeting of the European Parliament Interest Group on Mental Health, Well-Being and Brain Disorders.

Purpose (p. 7)

"This report sets out the current need, informs policy makers and all relevant stakeholders who influence care quality, and supports their commitment to creating a better future – not only for those with schizophrenia, but also for relatives and friends who currently carry the major responsibilities of caring for them."

Key Points (p. 9)

  • The likelihood of a good outcome for people with schizophrenia has improved in recent decades; with appropriate management, many people affected by the condition can now achieve an acceptable quality of life.
  • A modern approach to schizophrenia management should aim to move patients along a pathway towards recovery of normal function, as well as to alleviate distressing symptoms.
  • Driving further change towards a more positive outlook for schizophrenia requires fundamental policy change.

Recommendations for Policy Change (p. 11)

  1. Provide an evidence-based, integrated care package for people with schizophrenia that addresses their mental and physical health needs. This should be underpinned with an integrated approach bytheir healthcare professionals and supported by the national healthcare system and by educational and research facilities.
  2. Provide support for people with schizophrenia to enter and to remain in their community, and develop mechanisms to help guide them through the often complex benefit and employment systems to enhance recovery. Guidelines and educational programmes should be developed and implemented to support the inclusion of people with schizophrenia in their community, workplace or school.
  3. Provide concrete support, information and educational programmes to families and carers on how to enhance care for an individual living with schizophrenia in a manner that entails minimal disruption to their own personal lives.
  4. Consult with healthcare professionals and other stakeholders directly involved in the management of schizophrenia, including organizations that support people living with schizophrenia, their families and their carers, in order to regularly revise, update and improve policy on the management of schizophrenia.
  5. Provide support, which is proportionate to the impact of the disease, for research and development of new treatments that improve the overall outlook for people with schizophrenia, including those that target negative symptoms and cognitive impairment.
  6. Establish adequately funded, ongoing and regular awareness-raising campaigns to: increase the understanding of schizophrenia among the general public; emphasize the importance of positive societal attitudes towards mental illnesses; highlight available support for the management of schizophrenia; and deter discriminatory attitudes and actions. Such campaigns should form an integral part of routine plans of action.

Conclusions (p. 41)

  • Better lives for people living with schizophrenia: this is a reachable goal! We have come a long way towards achieving this in recent years, but much can (and should) still be done. Successful care requires an integrated team approach, involving psychiatrists, a range of healthcare professionals, social care providers and other external agencies. It also involves collaboration with people with schizophrenia, their families and other sources of support. For private healthcare systems, such a team approach will require careful alignment of reimbursement mechanisms to support high-quality care.
  • A second prerequisite for successful care is adequate funding – at least equivalent to that for other medical conditions such as cancer and heart disease – for research, treatment, services and teaching of future mental healthcare professionals. At present, the extent to which potentially effective psychosocial therapies are funded by public healthcare systems varies across countries; hence, many patients are denied treatment. More support is also needed for independent studies of potentially beneficial interventions.
  • Implementation of the recommendations set out at the front of this report, and in each chapter, will require engagement by every stakeholder: from policy makers at every level, from clinicians and from public agencies. With commitment from all, change can be achieved.

The 50-page report expands upon each of these points and recommendations, using data, definitions, family member and firsthand accounts, and visual aids. It also provides a glossary of terms and abbreviations to help inform policy makers.

In addition to APNA, the organizations who endorsed the report include the European Brain Council, European Federation of Associations of Families of People with Mental Illness, Global Alliance of Mental Illness Advocacy Networks-Europe, National Alliance on Mental Illness, National Council for Behavioral Health, Vinfen, and World Federation for Mental Health.

Special thanks to Mary Moller for her participation on this project.