Long term conditions means illness that are persistent, do not get better quickly and are hardly ever totally treated (Dowrick et al. 2005). In the UK there are about 17.5 million of with a long term condition according to the DoH and this has a financial impact on the country. There is a rise in number of people with long term condition, especially in developing countries (WHO, 2005). Poor countries are following up as they start adopting the lifestyle of developing countries (Holroyd and Creer, 1986)..
It is a condition of the brain that has an impact on how people think, feel and behave. It is a chronic mental illness which makes someone loses touch with reality known as psychosis. Its most common symptoms are delusions, having false beliefs that someone or some people are plotting against them or their family and hallucinations, hearing things that are not real. The disorder progresses slowly and prevents someone from living a normal life, becoming withdrawn, loss of interest and becoming angry.
When unwell, significant changes are shown in behaviour. For some occurs quickly, but for others it takes longer. The person can become sad, cause anxiety, confusion and wary of others, mostly those who don't agree with their views. The person can deny, or refuse to consider, that they need help.
During diagnosis, doctors exclude other physical or mental health issues. They search for several 'positive' and 'negative' symptoms, and do a diagnosis in accordance to the manifestation and duration of the symptoms.
'Positive' symptoms are those that majority people do not generally experience, which include thought disorder, hallucinations and delusions.
Thoughts and ideas are mixed-up and have no sense to others. Conversation is very hard and can cause being alone and isolated.
Hallucinations may affect a person senses by seeing things, smelling things and hearing voices or sounds that others don't.
Voices may be familiar or abnormal, friendly or serious and can argue persons' way of thinking or behaving. The voices they hear can tell them to do things. People who are diagnosed with schizophrenia appear to hear mainly critical or unfavourable voices. A person can hear voices all their life, but a stressful life event could make the voices tougher and harder to deal with.
Around 4 % of the people hear voices according to researches, but pose no problem and are not related to schizophrenia, for majority of people.
Delusions is when someone believe strongly in something that is not normally accepted in reality. Delusions can be difficult for someone, or those around, as they can be unusual or dangerous. For example, believing people are following them.
'Negative' symptoms are the loss of some emotional responses or thought processes, including a lack of interest, emotional irregularity, lack of ability to concentrate, a want to evade people or to be safe.
Being reserved, being indifferent, and not being able to concentrate are called as 'negative', because they show a decrease in thought or function. It is difficult to say if negative symptoms are part of the schizophrenia, or if they are here as people are responding to other symptoms. For example, someone with mental health issue can be discriminated making them isolated and depressed.
There are other forms of schizophrenia. The main is paranoid schizophrenia. If someone does not have all the symptoms for schizophrenia, they are diagnosed with 'borderline schizophrenia'.
In general it is agreed that schizophrenia is possibly caused by several elements, like someone's genes can increase their risk, but stressful life events could start the beginning of symptoms.
High level of dopamine which is a substance that carries messages in the brain can cause schizophrenia. Antipsychotics drugs are used to treat the disease by targeting the dopamine system.
Stressful life events
Stressful life events can cause schizophrenia according to studies and personal account. Boing socially isolated is also related to schizophrenia and other mental health problems. Homeless, poverty, unemployed, lost of someone close, physical or verbal abuse or harassment can all contribute. A study showed that more people who heard negative voices were abused sexually or physically.
Taking cannabis, cocaine and amphetamines can lead to symptoms of schizophrenia, and can make the symptoms worse for those who have it already, a study showed.
Consuming alcohol and smoking can impact on the effectiveness of medication to treat the symptoms of schizophrenia.
Some people are more likely to get schizophrenia because of their genes which makes them more vulnerable to the condition but not necessarily. Evidence shows that people whose parent has schizophrenia are more prone to develop it themselves; however, majority of people diagnosed have no family history.
Evidence shows that physical differences in the brain or injury may be related to schizophrenia.
In every hundred people, approximately one is diagnosed with schizophrenia and everyone will have not had the same symptoms.
Schizophrenia appears to affect men and women approximately equally with the majority being diagnosed between 18 and 35, with men being diagnosed at a younger age. There are a large number of African-Caribbean men in the UK diagnosed with schizophrenia for which there are no clear reasons. Migration, racism, and environmental and cultural differences are possible reasons. There can be a risk of mistaken diagnosis if the psychiatrist is of a different culture, religion or social experiences to their patient.
To treat and manage schizophrenia, the National Institute for Health and Clinical Excellence (NICE) has made guidelines which include psychological treatments, medication and services offered in hospital and in the community. Apart from medical treatment, help is offered for social issues that can affect mental health. NICE recommends getting help as soon as possible.
GP are more likely to refer someone to psychiatric services for primary assessment, treatment and care, and when treatment is decided, the GP is responsible for the continuing care.
There are different help available depending if someone has just been diagnosed or if they need more long-term support.
Staying well and recovering: Medication, talking treatments, transcranial magnetic stimulation (TMS).
In a crisis or when things are difficult: Rapid tranquillisation, Crisis services, Hospital admission.
Moving on and day to day challenges: Community care, Advocacy, Supported accommodation, Social and vocational training.
Staying well and recovering
Doctors normally prescribe antipsychotic drugs for the 'positive' symptoms. But as they act as a sedative, it makes it more difficult to deal with the side effects or to profit from talking treatments. In high doses the side effects are unpleasant including:
neuromuscular effects (shaky and stiff muscle)
antimuscarinic effects (blurry vision, fast heartbeat, constipation)
sexual side effects (development of breast, sexual desire loss, periods loss)
Past neuroleptic drugs, like chlorpromazine (Largactil) and haloperidol (Serenace, Haldol) have been linked with severe and long-term side effects like involuntary actions and muscle spasms which can be lasting.
The newer neuroleptic drugs are: risperidone, amisulpride, olanzapine, paliperidone, quetiapine which have been improved to have less side effects but they result in metabolic symptoms including weight gain, diabetes, high cholesterol and high blood pressure. Those having any of these drugs need to check regularly their weight, blood pressure and blood sugar. They can also treat 'negative' symptoms which are harder to deal with.
Neuroleptic drugs is available in tablet, syrup or injectable form, which can be taken daily, weekly, fortnightly or monthly.
Some take medication on short-term and stay well afterwards whereas some have long-term treatment. For those on long term, taking the lowest dose of the drug can be the best way to deal with symptoms and reduce the side effects. When taking the drugs, the dosage has to be regularly reviewed in order to keep it as small as possible. Someone may need to try more than one drug to find the best one. It will not make difference to the symptoms but it could decrease the side effects as some people discontinue taking medication due to the side effects whereas others find they can cope without medication. Those with liver, kidney and heart disease need to take the drugs carefully.
Talking treatments, like psychotherapy, counselling and cognitive behaviour therapy (CBT), may benefit to cope and treat schizophrenia by allowing people to find issues and find solutions by exploring the symptoms and overcome them.
NICE recommend CBT which is available on the NHS which is expensive privately but some services are free from voluntary organisations like Mind associations.
Transcranial magnetic stimulation (TMS)
TMS is a non-invasive and safe new treatment which stimulate the frontal regions of the brain by using magnetic impulses. It helps people with mostly 'negative' symptoms and those with auditory hallucinations.
Rapid tranquillisation is the use of drugs in an emergency to calm someone when other methods did not work. It is not used regularly as it has risks and is disturbing and people need to be explained of what happened afterwards.
Community Mental Health Teams (CMHTs) help people in a crisis by supporting them in their home and providing accommodation.
Those who feel distressed can go to hospital where they can feel safe but being around distressed people can be upsetting and there is less privacy and support can be difficult. On the other hand, service user or patient groups present in hospital are very beneficial and helpful.
Those who are reluctant to go to hospital can be forcefully admitted under the Mental Health Act.
Several support options are available to face daily challenges like community care , supported accommodation, advocacy and social and vocational training.
those referred to specialist mental health services:
get an in-depth health and social care needs assessment to form a care plan
review the care plan on an constantly
Work with a care coordinator or key worker to supervise care.
Someone is allowed to say their needs and have an advocate. The assessment can be attended by carers and relatives, which is known as the care programme approach (CPA).
The Community Mental Health Teams (CMHT) can perform the assessment. CMHT consists of several specialists like a psychiatrist whose role is to help people live an independent life and assists with matters like benefits and housing and also organising admission to day or drop in centres. community psychiatric nurse (CPN) can do home visit and provide medications and give other help. Occupational therapists help in developing new skills. A care assessment can also consist of someone need for care services in the community like day care and housing. Someone can also be assessed by social services.
Advocates workers are qualified and skilled people who can help someone to say their requirements or needs, accessing impartial data, and representing someone's opinions to others. Advocates can also help in getting community care services and legal representation.
Social Services and mental health organisations can offer supported accommodation allowing independent living with help available from staffs that provide different level of support.
Training are available to help in different ways, like how to travel on public transport, to looking for jobs, budgeting, dealing with social circumstances and resolving difficulties.
Self-help groups offer vital chance for people and their family to talk about how to deal with, discussing for improved services, or just supporting each other.
It is important to avoid stress. If someone has a job, they can decrease their hours, or work more flexibly. The Disability Discrimination Act 1995, says that all employers should make 'reasonable adjustments' to help the work of disabled people, together with those who have mental illness.
Some people who have schizophrenia get help from complementary therapies like homeopathy and creative therapies like art and poetry. Tai chi, yoga and relaxation methods can also help.
Researchers found a good diet containing EPA-rich fish oils found in sardines, pilchards and supplements is good because antipsychotic medicines causes risk to the physical health. Avoid stress, eat well, get enough exercise and sleep.
Someone who has schizophrenia does not mean 'split personality', or mean that he will change from being peaceful to being out of control. Majority of people who has schizophrenia do not commit crimes. The voices they hear is mostly to self-harm.
Long term neurological conditions
Long term conditions cannot be cured but can be controlled. When treating an acute disease, it return to normal whereas a chronic disease changes someone life's forever as the disease and its impact keep changing, which becomes very difficult to manage. LTC is linked to depression and other psychological problems. Living with LTC can affect someone in different ways like visiting the hospital and GP more frequently, undergoing medical treatment, financial problems and being socially isolated.
Living with LTC prevents someone from going to work, school and taking care of normal daily physical needs. Regardless of ages, those with LTC affecting their daily living are two times more likely to be not working and it also affect the health of their carers by causing fear for the future, depression/anxiety, breakdown of relationship and sex live, worry about patient suffering, impacts on their own health as carer, lack of sleep and tiredness, socialising problems by not wanting to go to places alone or as a result of looking after partner at home, financial problems as patient or carer need to stop working, funding expensive treatment and changes to adapt their home. (Rees et al. 2001)
The physical impacts of LTC can consist pain, disability and complications that require hospital treatment and development of short and long term complications.
LT neurological conditions
The NSF describes a neurological long term conditions as resulting from disease, injury or damage to the nervous system, affecting the person and his family for life in any way. Neurological conditions is responsible for one fifth of admissions in hospital and is the third reason for people to visit the GP, with around 350,000 people affected in the UK and around 850,000 looking after someone with a neurological conditions.
The National Service Framework classifies LT neurological conditions as:
Unexpected beginning conditions like obtained brain or spinal cord injury, followed by limited recovery.
Irregular and random conditions like epilepsy, some types of headache or multiple sclerosis, where deteriorations and reductions lead to clear difference in the care needed.
Advanced conditions, like motor neurone, Parkinson's diseases where slow decline in neurological functions lead to rise dependence on others for care.
Steady neurological conditions, but with varying requirements as someone becomes older, like post-polio syndrome or cerebral palsy in adults.
Based on the conditions and progression, long term neurological conditions can be linked to a number of problems like:
Physical or motor problems like incontinence, paralysis and fatigue.
Sensory problems like hearing and vision loss.
Cognitive and behavioural problems.
National service frameworks and strategies
National service frameworks (NSFs) and strategies put forward special necessities for care which are founded on confirmation of what treatments and facilities work best for patients. The strong point of the approach is that it is complete, as it has been established with the corporation of professionals in health, carers, patients, managers in health service, agencies in voluntary sector and other experts. The NSF foe mental health consists of a set of 7 standards.
Mental health promotion
The aim is to make sure that health and social services support mental health and decrease the bad perception and social segregation related to mental health complications by promoting mental health for everyone, working with people and the public and fighting discrimination against people with mental health complications, and support their social integration.
Standards two and three
Primary care and access to services
The aim is to provide improved primary mental health care, and to make sure regular assistance and support for those with mental health requirements, together with primary care services for individuals with severe mental disorder.
Patient contacting the primary health care group with a regular mental health condition need to have their mental health needs acknowledged and evaluated; providing good treatments consisting of specialist referral services for additional assessment, treatment and care if they need it.
Anyone with a mental health problem need to have contact anytime with the local services in order to meet their needs and be given sufficient care; and to use NHS Direct, for primary advice and recommendation to specialist.
Standards four and five
Effective services for people with severe mental illness
The aim is to make sure that anyone with severe mental illness gets the range of mental health services they require; and emergencies are foreseen or stopped where likely; to make sure that quick and good help in a crisis situation; and suitable admission to a proper and harmless mental health residence or hospital bed, comprising a safe bed, as near to home as possible.
All mental health service users on CPA need to be receiving care that enhances meeting, predicting or avoiding crisis, and decreases danger; and care plan including the procedures to follow in a crisis by the service user, their carer, and their care co-ordinator, advising their GP what to do if the service user needs extra help, reviewed on a regular basis by their care co-ordinator, having access to services anytime.
Anyone assessed as requiring care outside their home need to have appropriate access to a suitable hospital in a non-limiting place consistent with the necessity to safeguard them and the public, as near to home as possible; a care plan approved on release setting out the care and help to be given, allocating a care co-ordinator, and agreeing the step to follow in a crisis.
Caring about carers
The aim is to make sure that health and social services evaluate the requirements of carers who deliver regular and considerable care for people with severe mental disorder, and deliver care to meet their requirements.
Anyone who delivers regular and considerable care for a person on CPA need to have an evaluation of their care, physical and mental health requirements, done annually and have their own care plan given to them and applied in talking to them.
The aim is to make sure that health and social services contribute in reaching the target in Saving lives: Our Healthier Nation to cut the rate of suicide by at least one fifth by 2010.
Local health and social care groups need to stop suicides by supporting mental health for all, working with peoples and societies.