The abandoned illness: a report from the Schizophrenia Commission

One hundred years after the term “schizophrenia” was coined to describe severe psychosis, the Schizophrenia Commission came together to examine the provision of care for people living with psychotic illness. We are an independent group which took evidence from around the country and heard from several thousand people over 12 months. What we found was a broken and demoralised system that does not deliver the quality of treatment that is needed for people to recover. This is clearly unacceptable in England in the 21st century.

The inadequate care that many people with psychosis receive adds greatly to their distress and worsens the outcomes for what can already be a devastating illness. Most have a period in a psychiatric hospital unit but too many of these wards have become frightening places where the overwhelmed nurses are unable to provide basic care and support. The pressure on staff for increased “throughput” means that medication is prioritised at the expense of the psychological interventions and social rehabilitation which are also necessary. Furthermore, some wards are so anti-therapeutic that when people relapse and are in need of a period of care and respite, they are unwilling to be admitted voluntarily; so compulsion rates rise.

The problems are not just in the wards. People with psychosis rarely have the chance to choose their psychiatrist and families are not treated as partners in care but have to battle for basic services. People diagnosed as having schizophrenia have poor access to general practitioners and general hospital care; their physical health suffers and their life is shortened by 15 to 20 years. The fragmentation of services means that people who have a recurrence of their psychosis lose the established relationships with professionals they trust, and instead feel shuttled from one team to another as if on a factory production line.