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This report will look at service users who suffer with schizophrenia, it will highlight what schizophrenia is. The needs of service users who suffer from schizophrenia will be identified including; personal, interpersonal, social, educational, accommodation and medication needs. The services available to service users which meet these needs will also be identified.
What is Schizophrenia
Schizophrenia is a complex disorder with a number of variants, although the prognosis is well understood by specialists. It is a neuropsychiatric disorder where a number of factors may have impacted upon the central nervous system and which results in a cluster of symptoms that are classified as schizophrenia. It is commonly thought, incorrectly, by the general public to be associated with dangerous and extreme madness and thus carries a stigma which other diagnoses do not (Eldergill 1997).
About one in 100 people will have one episode of schizophrenia, and two thirds of these will go on to have further episodes. Schizophrenia usually starts in the late teens or early 20s, but can also affect older people for the first time. The causes are unknown but episodes of schizophrenia appear to be associated with changes in some brain chemicals. Stressful experiences and some recreational drugs can also trigger an episode in vulnerable people. (www.mentalhealth.org)
Needs of service users with schizophrenia
An individual’s personal needs include;
Good basic personal hygiene; this may include assistance to wash and brush their teeth or the individual may need prompting/reminding do so.
Having clean fitting clothing; help or prompting again may be needed to assist the individual to get dressed.
Food and drink supplies; individuals may need assistance shopping or making meals, to ensure good diet and physical health.
It is important that individuals gain support from their family, friends and professionals.
Awareness of the individual’s illness and needs is also paramount.
It would also be useful to the individual if their family and friends have an idea of what causes their episodes and ways of defusing the situation or a point of contact when these situations arise.
It is important that the individual does not feel excluded from society because of their illness.
To be able to carry out social activities on a regular basis
Meet other people with the same illness; this can provide an understanding of their illness as well as peer support.
Education about their illness and also education for their family and friends.
What to do or who to contact when experiencing the onset of a psychotic episode.
Education on ways to prevent or control the psychotic episodes.
Stable adequate housing.
Depending on the severity or their illness; supported living or residential accommodation.
It is important that the service user understands what medication they are taking, if any.
What the medication does.
Side effects of the medication.
The National Service Framework for adult mental health has seven standards;
Standard one covers mental health promotion and aspects of discrimination and social exclusion that is associated with mental health problems.
Standards two and three cover primary care services for people who have mental health problems and include 24-hour crisis services.
Standards four and five highlight what is needed to provide effective services for people with mental health problems. This includes being familiar with the care programme approach and its relation to care management.
Standard six relates to the individuals who care for people with mental health problems, with social service departments being given the lead responsibility in ensuring that all carers’ needs are assessed and that they receive their own written care plans.
Standard seven sets out what is needed to achieve a reduction in suicides. This will potentially involve all social workers in a range of settings. (Golightley 2009)
Social services are put in place to assist people who are experiencing a crisis or are in need of ongoing support. The adult mental health services would be the provider of this service to individuals with schizophrenia. Golightley (2009) highlights the role of social workers working with sufferers of a mental illness to be;
Educating service users and their families about their illness.
Helping to arrange appropriate low stress accommodation.
Networking with the service user to provide community support.
The use of behavioural techniques to modify behaviours.
Encouraging compliance with medication.
Acting as an advocate for the service user where appropriate.
It is important that social workers are able to identify whether the service user is a risk to either themselves or others. If so it is important to identify the risk and a way to manage it.
MIND the mental health charity state that General practitioners are usually the first point of contact for individuals who believe that they are experiencing the onset of a mental illness. GP’s can offer advice and referral to other specialised mental health services and treatments. It is also possible for them to prescribe anti-psychotic medication once assessing an individual’s situation and they feel the individual would benefit from it.
After diagnosis GP’s still play an important role in individuals’ aftercare and physical health. The GP will be able to provide advice about the medication, what it does and its side effects. “According to the Government, GPs play a central role in the care and treatment of people with mental illness.” (Department of health 2001)
Community mental health teams
Community mental health teams are put in place to assist and treat service users who suffer from mental disorders which primary care teams cannot treat including schizophrenia. Community mental health teams usually consist of professionals such as;
All of these professionals work alongside each other as part of a multidisciplinary team. They create individual care plans for each service user and assist them to either maintain their disorder or work towards full recovery depending on the severity of their disorder.
To access the services of the community mental health team service users would need to be referred by their general practitioner, social worker or health visitor. These professionals will only refer individuals to this service if they believe that it would be appropriate and their patient would benefit from the services they have to offer. Once the service user has been referred, they will receive an assessment from the community mental health team which will determine the next steps for them to take towards recovery. The assessment will give the service user a diagnosis .Depending on the outcome of the assessment their next steps may include; advice, treatment or ongoing support from the team and in some cases referral to another service which specialises in their disorder. (www.mind.org.uk 2012)
Early intervention service
There is some evidence that early intervention can prevent psychosis and can help to prevent some of the worse consequences of psychosis, such as periods of unemployment, misuse of drugs or alcohol, getting into trouble with the police or becoming depressed. (Care services improvement partnership and national institute of mental health England 2006)
The early intervention team is part of the wider community mental health team framework. This service is specially designed for sufferers of schizophrenia and associated psychotic illnesses. This service aims to assist people who are at risk of experiencing their first episode of psychosis or are in the early stages of a psychotic illness. The early intervention team consists of;
Community psychiatric nurses
They aim to improve the effectiveness of short and long term treatment by; providing prevention strategies, detection of illness, support and treatment in the early stages of psychosis (www.mind.org.uk 2012).
Crisis resolution and Home treatment
To access this service, service users are usually referred by a community mental health team, general practitioner, social worker or health visitor, although it is possible for service users to refer themselves
The team is staffed by mental health professionals including; Psychiatrists
Mental health nurses
They provide intensive and rapid support for people aged 16-65 years old who are experiencing a mental health crisis and who, without the team’s help, would be admitted to a psychiatric hospital. Sometimes the CRT can support people in their own homes, shortening their stay in a psychiatric hospital. For people in the community, CRTs arrive quickly – ideally within an hour. The team is then available 24 hours a day, seven days a week. Support continues for as long as it is needed or until the person transfers to another service (www.mind.org.uk 2012).
Burton (2009) describes the crisis resolution and home treatment team as the gatekeeper to other mental health services, prompt assessment of an individual suffering a crisis, community based care, remain involved throughout the crisis, undertake crisis prevention planning and work in partnership with the sufferer, family and carers.
If service users feel they are not ready to live in the community independently or supported, residential care may be the next step for them to take. Residential care services provide service users with rehabilitation and support if they are suffering with a severe long term mental illness. This service provides 24-hour care by residential social workers, nurses and mental health support workers. Care homes are for people who need a high level of care and find it hard to manage in their own home (www.mind.org.uk 2012).
This service can be accessed by having a community care assessment, service users may have to pay for this service as it is means tested.
Service user groups
Service user groups are put in place to assist service users of all types. Each group is tailored to suite specific service user groups. Service user groups that specialize in assisting individuals with personality disorders, emotional or behavioural difficulties would benefit sufferers of schizophrenia. These specific groups aim to make service users feel; supported, empowered, included and a part of something. New coping strategies are provided which can lead to service users experiencing fewer crises.
‘Self-help and peer-support groups enable people to meet and share information, friendship and support. They often bring together people with a similar mental health issue, on a short- or long-term basis.’ (www.mind.org.uk 2012)
Talking therapies, such as psychotherapy, counselling and cognitive behaviour therapy (CBT), can help to manage and treat schizophrenia. Talking treatments help individuals to identify the things they have issues with, explore them and discuss strategies or solutions. They can allow individuals to explore the significance of their symptoms, and so to defeat them. (www.mind.org 2012)
Cognitive behaviour therapy can be accessed through the NHS service users can access these service through their GP. Many voluntary associations including MIND offer these services at no cost.
There is financial help available to those who cannot work due to a mental illness. These benefits can help towards care, rent and other commitments.
Disability living allowance
Service users who suffer from a mental disability such as schizophrenia may be eligible to claim this benefit whether they are working or not. Disability living allowance is a tax free benefit put in place to help with extra costs you have because of your disability.
To apply for this benefit service users must first apply through the jobcentre plus, their social worker or support worker would be able to assist them with this process. The claimant may then need to undergo a medical examination in order to receive the benefit. Receiving this benefit could increase the amount of other benefits the service user is entitled to. (www.direct.gov.uk)
Housing benefit can provide individuals on a low income with financial support to pay their rent. How much each individual receives depends on their circumstances. Housing benefit depending on the service users’ income can pay all or part of their rent. Individuals are eligible to apply whether they are working or not, they can apply through their local council or jobcentre plus by filling in a housing benefit form.(www.direct.gov.uk)
Council tax benefit
Service users can apply for council tax benefit through their local council. Depending on individual circumstances service users may be eligible to get all or part of their council tax bill paid. Individuals can get a council tax benefit claim form from their local council.
Department of Health (DH), 2001, The Mental Health Policy Implementation Guide, London: DH.
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