Homelessness and Poverty due to Lack of Treatment of Paranoid Schizophrenia - Research Paper Example

?In Presentation 01: Paranoid Schizophrenia: Homelessness and Poverty due to Lack of Treatment DE-Section E801 Semester 1106 University of . . . 26 July 2011 1. Introduction   Schizophrenia is a mental illness that commonly afflicts men at their late adolescent life or early adulthood, but it can strike a person at any stage in life. Although it occurs in women as much as men, the illness peaks in women in the 20s and early 40s. It is a disabling disease in that the normal functioning of persons suffering from it is hampered. It develops very slowly that detection cannot be made but when it appears, it worsens fast. When the disease starts to manifest, the person affected show remarkable changes in behavior. As a recognized major cause of disability, the person affected will be unable to perform basic care for oneself or regular day-to-day activities, communicating will be hampered, and performance of duties at work will be restricted. Due to the symptoms of the disease, a person will be unable to manage the normal daily activities, including work and social relationships. With this disease, a person will have a perception of reality very different from how normal persons do. Schizophrenic persons suffer from hallucinations, delusions and illusions. The schizophrenic may “hear” voices or believe that other people are reading his or her mind. Paranoid schizophrenia is one of the types of this disabling disease, with the others as follows: catatonic (characterized by lack of movement or peculiar movement), disorganized (characterized by disorderly thought), residual (with mild positive symptoms), schizoaffective disorder (combination of schizophrenic symptoms and mood disorder, e.g. major depression, bipolar mania, mixed mania), and undifferentiated (does not fall under the other categories). This mental disorder affects all people regardless of status in life. Reports indicated that Canada has one person diagnosed with it for every 100, or around 300,000 persons. In paranoid schizophrenia, a person will experience prominent delusions and auditory hallucinations. The delusion may consist of believing that the person is being controlled by something, or the afflicted person has control over forces of nature, etc. The delusions in this type of schizophrenia may include thinking of being persecuted. The affected person may also harbor ridiculous beliefs that others, including family members, are conspiring, cheating, or harassing him or her. These persons also hear voices or believe that others can read their mind or control their thoughts. Thus, they become afraid, withdrawn and isolated. Studies revealed that many homeless and impoverished individuals suffer from mental illnesses and schizophrenia. Paranoid schizophrenia cannot be cured but treatment can relieve the symptoms. A very small number, though, has been said to recover from schizophrenia. The lack of treatment of paranoid schizophrenia often leads to homelessness and poverty especially when the person afflicted becomes withdrawn and isolated from family and friends. This type of schizophrenia can be treated in the same manner as other types but differentiation may depend on the symptoms and severity of the disease. A psychiatrist primarily provides the treatment but a multi-disciplinary team (with a psychiatrist, psychotherapist, family doctor, social worker, family member, etc.) would be more advantageous in the treatment process. Early detection would also allow for early treatment, and thus avoid the worsening of the condition. 2. Selected Literature Seven peer reviewed and scholarly articles are used in this the current discourse to elucidate on paranoid schizophrenia and its relation with poverty and homelessness: Bellack, A.S. (2001). Psychosocial treatment in schizophrenia. Schizophrenia: Specific Topics. J. Macher (Ed.). Dialogues in Clinical Neurosciences, 3(2), 71-145. ISSN 1294-8322. Retrieved 18 July 2011, from http://www.dialogues-cns.org/brochures/09/pdf/09.pdf Felix, A., Herman, D., & Susser, E. (2008). Housing instability and homelessness. In K.T. Mueser & D.V. Jeste (Eds.). Clinical handbook of schizophrenia. New York: The Guilford Press. Retrieved 17 July 2011, from http://www.alnemiga.com/pharm/Handbook_of_Schizophrenia.pdf Homelessness: One of the consequences of failing to treat Individuals with severe psychiatric disorders. (2009, April). Treatment Advocacy Center Briefing Paper. Retrieved 17 July 2011, from http://www.treatmentadvocacycenter.org/storage/documents/homelessness--apr_09.pdf Learning about schizophrenia: Rays of hope. (2003). A Reference Manual For Families & Caregivers. 3rd ed. Schizophrenia Society of Canada and Pfizer Canada Inc. ISBN 0-9733913-0-8. Retrieved 17 July 2011, from http://www.schizophrenia.ca/Rays_of_Hope.pdf Mental health, housing and homelessness in Australia. (2009, March). Home Truths. Retrieved 17 July 2011, from http://www.mhca.org.au/documents/MHCA Home Truths Layout FINAL.pdf Mueser, K.T. & Jeste, D.V. (Eds.) (2008). Clinical handbook of schizophrenia. New York: The Guilford Press. Retrieved 17 July 2011, from http://www.alnemiga.com/pharm/Handbook_of_Schizophrenia.pdf National Collaborating Centre for Mental Health (2010). Schizophrenia: The NICE Guideline on core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. ISBN: 978-1-854334-79-4. New York: Retrieved 18 July 2011, from http://www.rcpsych.ac.uk/files/samplechapter/NICEschizUpEdSC.pdf Parker, S., Limbers, L. & McKeon, E. (2002, April). Homelessness and mental illness: mapping the way home. Mental Health Coordinating Council. Retrieved 17 July 2011, from http://www.mhcc.org.au/documents/Homelessness-and-Mental-Illness-Apr02.pdf 3. Commentary Regarding the Selected Literature. Literature Source 1: Bellack (2001). Schizophrenia is a disorder that strongly affects the patient’s relationship with one’s family, relatives, friends and society. Therefore, treatment must not only focus on medication but on the psychosocial aspect of the person, too. The four psychosocial treatment strategies that have been scientifically recognized (though further research is necessary) are as follows: a) social skills training, b) family psychoeducation, c) cognitive therapy, and d) cognitive rehabilitation. Training on social skills would capacitate the patient to learn certain behaviors which are necessary for him or her to succeed in interacting with other people (Bellack, Mueser, Gingerich et al., 1997; Liberman, 1995, as cited in Bellack, 2001). Family psychoeducation requires the participation of the family in the whole treatment process. This approach includes providing information on schizophrenia to family members, respect for the family with such patient, and educating the family on “less stressful and more constructive strategies for communication and solving problems” (Bellack, 2001, p. 137). Cognitive behavior therapy is a coping strategy that reduces distresses resulting from delusion and hallucination through self-talk or rational analysis (Birchwood & Tarrier, 1992; Wykes, Tarrier & Lewis, 1998, as cited in Bellack, 2001). Medication has only partially improved the neurocognitive impairments of a patient. Through cognitive rehabilitation, the patient will be given exercises to enhance memory, increase attention and solve complex problems (Brenner, Kraemer, Hermanutz et al. 1990; Wykes, Reeder, Corner et al. 1999, as cited in Bellack, 2001). The psychosocial treatment strategies would be highly helpful to the patient if he or she is still having contact or living with the family. In this manner, the patient would be capacitated to cope with the situation and still engage in work with minor tasks. Thus, he or she would not succumb to poverty and homelessness. However, if the patient isolated oneself and left the home, then, he or she will not be able to avail of psychosocial treatment and medications. This would worsen the schizophrenic symptoms. The government, on the other hand, may not be able to place in the institution all the homeless schizophrenics to give them psychosocial treatment. Literature Source 2: Felix, Herman & Susser (2008). In Chapter 40 of “Clinical handbook of schizophrenia,” Felix, Herman and Susser mentioned that homelessness and unstable residence are hindrances to access to treatment and medical care. However, the authors also mentioned that lack of treatment could lead to homelessness. They said that clinicians must understand the relationship between “severe mental illness (SMI) and homelessness” in order to diminish homelessness and related outcomes (Felix, Herman & Susser, 2008, p. 411). Rigorous researches have revealed that a high percentage among the homeless people has SMI, and that includes schizophrenia. In the study made by Folsom et al. (2005, as cited in Felix, Herman & Susser, 2008), an estimate of 15 percent of schizophrenic individuals had undergone homelessness for over a year in San Diego. In Philadelphia, 10 percent of the people with SMI has utilized the public shelter within a period of three years (Culhane, Averyt & Hadley, 1977, as cited in Felix, Herman & Susser, 2008). Occurrences within the family such as abuse, neglect or negative experiences among SMI persons lead to homelessness. The authors said that homelessness affects treatment of the disorder, but they did not elaborate on the lack of treatment that causes homelessness and poverty. Literature Source 3: Homelessness (2009). Between 150 to 200 thousand individuals of the approximated 744,000 homeless in America are either schizophrenic or manic-depressive. There are always more than double the number of persons with severe mental illnesses, at any period of time, on the streets than those receiving treatment at hospitals. Statistics show that the number of mentally ill persons that roam the streets is continually on the rise. And many of deinstitutionalized patients return back on the streets. A research in 1989 revealed that 27 percent of the 187 patients discharged from Metropolitan State Hospital (Massachusetts) was homeless in the past six months. It was also found out that inability to take medication, along with substance abuse, is a prime predictor of homelessness. Sixty three percent of the homeless was unable to take medication while a mere 18 percent had not done so for those under hospital care. From the data gathered, it was deduced that “increasing compliance with medication would significantly decrease homelessness” of persons with grave mental illness (Drake, Wallach & Hoffman, 1989, as cited in Homelessness, 2009, p. 3). Lending credence to this conclusion is the study conducted with 132 patients released from Columbus State Hospital (Ohio) where 36 percent succumbed to homelessness within six months from discharge. This literature discussed in passing that failure to take medication or undergo treatment would lead to homelessness. It also mentioned that patients who were discharged from the institution became homeless from date of release. No literature that extensively studies the relationship between lack of treatment of the disorder and homelessness and poverty was found, although logically, that would be the result because it is a disabling disease. If schizophrenia is mentioned in connection with homelessness, it deals with the disorder in general and not specifically on the sub-category paranoid schizophrenia. Literature Source 4: Learning about schizophrenia (2003). The exact cause of schizophrenia is not known but with the changes occurring in the brain; it appears that the focal point of the disease is the brain. Since it affects perception, emotion, behavior, etc., scientists suspect the involvement of neurotransmitters, dopamine, serotonin, thalamus, limbic system, and other areas of the brain. It was also said that the genes have a key role in the occurrence of the disease. When a person is afflicted by schizophrenia, the twin, family member or relative would have the greater risk of having the disorder, too. There is no specific gene associated with schizophrenia, but researchers are zeroing in on some areas in the chromosomes where the genes may most probably be located. Identifying the genes in the future will provide better diagnosis of the disease, and development of appropriate treatments. The following have been found to trigger or aggravate symptoms of the illness: stress, infections, drugs abuse and alcohol use. It is not caused by an abusive parent, parental neglect, guilt, failure, poverty or childhood experience. It is a biological illness in the brain determined through internationally approved symptoms, and usually occurs between the ages of 15 to 25 years old. The principles of treatment suggested for schizophrenic patients are the following: a) developing strong and lasting relationship with treatment team, b) providing comfort to the patient (life is distressful), c) providing a holistic and personalized treatment, d) continuous intensive treatment regimen that would last for years, e) providing treatment appropriate for the age of the patient and stage of the disease, f) carefully planned pacing and reintegration of the patient into the mainstream, and f) involvement of the family as early as possible (Ehmann & Hanson, 2002, as cited in Learning about schizophrenia, 2003). This literature focuses on the genes as the origin of the disease. Since the schizophrenic gene is found in the chromosome, it can be inherited and transferred along biological lines. Following this line of thought, no one is immune from the disorder if the person has acquired the genes. Early detection and treatment are imperative in order to avert worsening of the symptoms, which could lead to withdrawal and isolation, severance from work, and poverty and homelessness in the future. Thus, the first line of assistance to the afflicted person would come from family members and close associates. They must endure the challenges that come along and have patience so that the afflicted member of the family may be able to learn again to interact socially. Literature Source 5: Mental health, housing and homelessness in Australia (2009). In Australia, the same trend has also been recognized. People with mental illness will have limited access to a decent income, especially if they do not have a permanent home or have unstable housing. The problem of access to shelter still remains with people afflicted with the disease. Mental illness may come first before homelessness, or may result from homelessness. But no matter whichever comes first, a homeless person with a mental illness would have difficulty in pursuing the required treatment. Literature Source 6: National Collaborating Centre (2010). In studying the cause of schizophrenia, the cause has been pointed to the interplay of interplay of social, psychological and biological factors. Newer studies are also geared towards identification of environmental stressors such as that made by Broome et al., (2005, as cited in National Collaborating Centre, 2010) on brain biochemistry and Craddock et al. (2005, as cited in National Collaborating Centre, 2010) on genes that allow susceptibility. In the recent trend on investigating the social and environmental influences on the onset of the disease, several researches (Arseneault et al., 2004; Bebbington et al., 2004; Moore et al., 2007; Read et al., 2005; van Os et al., 2005, as cited in National Collaborating Centre, 2010) said that birth in an urban setting, urban rearing and social conditions increase the risk of having schizophrenia. The disease is also high among some minority ethnic groups which tend to suggest that race might be a contributing factor (Cantor-Graae & Selten, 2005; Kirkbride et al., 2006, as cited in National Collaborating Centre, 2010). The disease is also exacting a huge cost for both the family and society. The lifetime cost (direct and indirect) for a person would range from ?8,000 to ?535,000 (for long-term hospital care) (Davies & Drummond, 1994, as cited in National Collaborating Centre, 2010), and around ?6.7 billion, based on the 2004-2005 prices in England, total cost on society (Mangalore & Knapp, 2007, as cited in National Collaborating Centre, 2010). There may be more factors that need to be explored to fully understand and treat schizophrenia, and the paranoid sub-type. It is enlightening that other aspects are being taken into consideration, such as ethnicity which could lead to the onset of the disease. The high cost of treating schizophrenia is very prohibitive. Thus, families of ill persons would find it hard to sustain the treatment even if the patient did not leave the family. Moreover, with such a high cost, the government may not be in a position to provide ample treatment and care for the entire homeless paranoid schizophrenic. Literature Source 7: Parker, Limbers & McKeon (2002). The health and social services sectors have recognized for a long time the relationship of homelessness and mental illness. It was observed during the end of the century that mental disease is reflected in a higher percentage among the homeless people than the general population (e.g. 2 to 90 percent, Breakey, p. 385, as cited in Parker, Limbers & McKeon, 2002). Researchers in the US also concluded in 1978 that “mental illness had come to personify homelessness” (Reich & Siegel, 1978, as cited in Parker, Limbers & McKeon, 2002, p. 4). The increasing advancement in the diagnostic tools in psychiatry allowed to discriminate clearly the variety and beginning of the disease, as well as the relationship between the mental illness and homelessness (Drake et al. in Breakey, page 339, as cited in Parker, Limbers & McKeon, 2002). The dysfunction in the family may result to personal dysfunction during childhood, that leads to low adjusting mechanism and greater chances of becoming homeless (Fischer et al, 1996, as cited in Parker, Limbers & McKeon, 2002). And due to the illness, the individual will have lesser employment opportunities, lower income, and less permanent place to stay. This literature reports that there is a relationship between mental disorder and homelessness. It also mentioned that dysfunction in the family could cause personal dysfunction of the ill person, and which could lead to unemployability and homelessness. However, lack of treatment of the mentally ill person that would lead to homelessness or poverty was not included in the discussion. 4. Questions Dealing With The Above Issues. A. Given the generality of the studies conducted on mental disorders and homelessness, would it be possible at present to determine the percentage of homeless paranoid schizophrenics among the population of homeless people with mental disorders? B. Which would you think is the stronger thesis: a) lack of treatment of the paranoid schizophrenia leads to poverty and homelessness, or b) poverty and homelessness causes lack of treatment of paranoid schizophrenia? C. With the high cost associated with the treatment of paranoid schizophrenic, which surely is a burden for the family, don’t you think that the government has to shoulder the cost of the treatment to avert homelessness and poverty? D. It was mentioned earlier that studies were made to correlate the genetic aspect with schizophrenia. Since the exact gene or chromosome responsible for the illness has not been identified yet, is it appropriate at this time to point to genes and biological inheritance as the cause of the disease? 5. Other Sources For Consideration (Optional): Published Article: Snyder, K., Gur, R.E., & Andrews, L. W. Me, Myself, and Them: A firsthand account of one young person's experience with schizophrenia. (2007). Adolescent Mental Health Initiative. The Annenberg Foundation Trust. Oxford University Press. Retrieved 18 July 2011, from http://www.copecaredeal.org/Files/Teens/MeMyselfandThem_EN.pdf References Bellack, A.S. (2001). Psychosocial treatment in schizophrenia. Schizophrenia: Specific Topics. J. Macher (Ed.). Dialogues in Clinical Neurosciences, 3(2), 71-145. ISSN 1294-8322. Retrieved 18 July 2011, from http://www.dialogues-cns.org/brochures/09/pdf/09.pdf Felix, A., Herman, D., & Susser, E. (2008). Housing instability and homelessness. In K.T. Mueser & D.V. Jeste (Eds.). Clinical handbook of schizophrenia. New York: The Guilford Press. Retrieved 17 July 2011, from http://www.alnemiga.com/pharm/Handbook_of_Schizophrenia.pdf Homelessness: One of the consequences of failing to treat Individuals with severe psychiatric disorders. (2009, April). Treatment Advocacy Center Briefing Paper. Retrieved 17 July 2011, from http://www.treatmentadvocacycenter.org/storage/documents/homelessness--apr_09.pdf Learning about schizophrenia: Rays of hope. (2003). A Reference Manual For Families & Caregivers. 3rd ed. Schizophrenia Society of Canada and Pfizer Canada Inc. ISBN 0-9733913-0-8. Retrieved 17 July 2011, from http://www.schizophrenia.ca/Rays_of_Hope.pdf Mental health, housing and homelessness in Australia. (2009, March). Home Truths. Retrieved 17 July 2011, from http://www.mhca.org.au/documents/MHCA Home Truths Layout FINAL.pdf National Collaborating Centre for Mental Health (2010). Schizophrenia: The NICE Guideline on core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. ISBN: 978-1-854334-79-4. Retrieved 18 July 2011, from http://www.rcpsych.ac.uk/files/samplechapter/NICEschizUpEdSC.pdf Parker, S., Limbers, L. & McKeon, E. (2002, April). Homelessness and mental illness: mapping the way home. Retrieved 17 July 2011, from http://www.mhcc.org.au/documents/Homelessness-and-Mental-Illness-Apr02.pdf Snyder, K., Gur, R.E., & Andrews, L. W. Me, Myself, and Them: A firsthand account of one young person's experience with schizophrenia. (2007). Adolescent Mental Health Initiative. The Annenberg Foundation Trust. Oxford University Press. Retrieved 18 July 2011, from http://www.copecaredeal.org/Files/Teens/MeMyselfandThem_EN.pdf Read More