Statutory mental health services and support for families with schizophrenia - Literature review Example

?Sta y mental health services and support for families with schizophrenia Using meta-analysis, the study of Pilling et al. (2002) investigated the efficacy of family interventions and cognitive behavioural therapy in dealing with schizophrenia. According to Pilling et al. (2002), the two modes of intervention are among four types of psychological interventions that were identified by the literature search to have been tested using randomized controlled trials---the other two are social skills training and cognitive remediation. Based on meta-analysis, the study of Pilling et al. (2002, p. 763) showed that “family therapy, in particular single family therapy, had clear preventative effects on the outcomes of psychotic relapse and readmission, in addition to benefits in medication and compliance.” On the other hand, again based on a meta-analysis, cognitive behavioural therapy resulted to improvements in mental states and is correlated with low drop out rates (Pilling et al. 2002). The most important content of the study of Pilling et al. (2002, p. 763), however, is its conclusion that “family interventions should be offered to people with schizophrenia who are in contact with carers” while cognitive behavioural therapy may be applied to “those with treatment resistant symptoms.” Although Pilling et al. (2002) carefully qualified that their findings must be validated through “large trials across a variety of patients,” the Pilling et al. (2002) findings indicate nevertheless a good role for family interventions. This is especially so given “that pharmacological treatment on its own is rarely sufficient for the best outcome” in managing schizophrenia (Pilling et al. 2002, p. 763). According to Pilling et al. (2002, p. 763, citing the work of Kane 1996), it has been generally held that “a significant proportion of patients, perhaps up to 40%, have a poor response to antipsychotic medication and continue to show moderate to severe psychotic symptoms.” Citing the work of Liberman (1994), Pilling et al. (2002, p. 764) emphasized that “antipsychotic drugs have limited impact on the negative symptoms of schizophrenia, and thus do not contribute to the development of the skills necessary for successful transition” or reintegration of the schizophrenic into the community. Knudson & Coyle (2002, p. 3) defined the “positive” symptoms of schizophrenia as the “florid manifestations” like hallucinations, delusions, and thought disorder as distinct from the negative symptoms such as “deficits in functioning” like isolation and withdrawal. According to Knudson & Coyle (2002, p. 3), “the negative symptoms are more persistent across time, do not respond well to medication.” Pilling et al. (2002, p. 764) enlightened that the modern treatment for schizophrenia is founded on “the impact of the social environment on mental illness.” Citing various authors, Pilling et al. (2002) said that modern treatments of schizophrenia use the concept of “expressed emotion” and the stresses the need for the family’s role in promoting “expressed emotions.” It follows that there is strong need for the family, especially the parents, to be supported well in caring for their family member who is diagnosed with schizophrenia. Support for parents of schizophrenic implies that there is strong need as well for the parents of schizophrenic to be supported emotionally. Using qualitative research techniques, Knudson & Coyle (2002) interviewed eight parents of people with schizophrenia in the United Kingdom and found that “support from social networks and mental health services were generally perceived to have been lacking” (p. 2). However, “both informational and emotional support were available from self-help groups for relatives/carers” (Knudson & Coyle 2002, p. 2). According to Knudson & Coyle (2002), their findings are significant on family members with schizophrenics to take care of because “60% of individuals with schizophrenia continue to live with their relatives, mostly with parents” (Knudson & Coyle 2002, p. 3). One weakness of the Knudson & Coyle (2002) study is that the qualitative research involved only a handful of sample of eight people. This is a serious weakness because a larger sample would probably result to more and richer insights on the difficulties encountered by parents who have children who are schizophrenic. Yet, Knudson & Coyle (2002, p. 5) justifies their design by citing that their aim “was to develop a theoretically enriched understanding of the experiences reported by participants.” Nevertheless, a greater sample would have accommodated a larger number of cases and may reveal, for example, the role played by race, ethnicity, and income variables on how community mental health teams or statutory services are able to help families assist their family members diagnosed with schizophrenia. According to Knudson & Coyle, one coping strategy that parents adopt when confronted with low emotional support for their difficulties in handling their children with schizophrenia was to provide rational explanations for the delusional beliefs of their sons or daughters (2002, p. 6). Yet, at the same time, most of the respondents eventually found their coping strategy ineffective (Knudson & Coyle 2002, p. 7). Meanwhile, according to Knudson & Coyle (2002, p. 8), another coping strategy that parents adopt is a cause for concern: an absence of normal functions which the schizophrenic was once able to do is “attributed to an unwillingness on the part of the diagnosed with schizophrenia to engage in appropriate behaviours, rather than being seen as symptoms” of an illness. Parents of schizophrenics also feel that they have been sidelined and expressed a need to be part of the treatment process of their sons of daughters diagnosed with schizophrenia (Knudson & Coyle 2002, p. 17). The parents’ desire to be part of the treatment process of their sons or daughters who are schizophrenics are most likely reflecting that parents of schizophrenics need emotional support to which statutory mental health services programs must respond. Knudson & Coyle (2002, p. 20) expressed the need for mental health professionals to create ways for parents “to focus on their own emotional well-being.” This is important because it “may serve the dual purpose of improving parents’ psychological well-being and protecting their offspring from any undue pressure or stress” (Knudson & Coyle 2002, p. 20). Prytys et al. (2011) investigated the attitudinal factors among community mental health team (CMHT) that may affect the implementation of the guidelines of the National Institute for Clinical Excellence (NICE) for psychological therapies and found that although CMHT and their coordinators have a positive view on the guidelines, their pessimistic view on client recovery can affect the implementation of the NICE guidelines. It follows that the pessimistic views of the CMHT and their coordinators also affect how the CMHT are able to provide emotional support to the parents of schizophrenics. According to Prytys et al. (2011) the situation implies that training programs should consider staff attitudes and knowledge so mental health services are able to well to people with schizophrenia as well as their families. Prytys et al. (2011) also revealed an important point: access to psychological therapies for those with a diagnosis of schizophrenia continues to be limited. Once again, echoing the discussion of Knudson and Coyle (2002), Prytys et al. (2011) affirmed that there is a substantial body of research that support the efficacy of cognitive behavioural therapy and family intervention for psychosis. Prytys et al. (2011) emphasized that cognitive behavioural therapy and family interventions are continued to be recommended by the NICE guidelines in managing schizophrenia. In summary, the literature that we have reviewed strongly supports the role of the family in the management of schizophrenia. Parents of people diagnosed with schizophrenia continues to have an important role in reintegrating the latter to the community and community mental health services must continue to focus also on them other than maintain the usual focus on people with schizophrenia. The qualitative methods employed in some of the studies may be criticized for using only a small sample but we must remind ourselves that only one case is needed to establish that a case exist. Although quantitative studies are needed to determine the exact prevalence or incidence of pessimism among the community mental health team on the recovery of people with schizophrenia and the need of their parents for emotional support, the qualitative studies are adequate nonetheless to establish the problems exist even if reliable estimates on the problem’s prevalence and incidence are not immediately computable. References Kane, J (1996) ‘Treatment resistant schizophrenic patients’. Journal of Clinical Psychiatry. 57 (suppl. 9) pp. 35-40. Knudson, B. & Coyle, A. (2002) ‘Parents’ experiences of caring for sons and daughters with schizophrenia: A qualitative analysis of coping. Manuscript of European Journal of Psychotherapy, 5 (2) pp. 169-183. Available at: http://epubs.surrey.ac.uk/1718/1/fulltext.pdf [Accessed: 29 January 2012}. Liberman, R (1994) ‘Psychosocial treatments for schizophrenia’. Psychiatry. 57 pp. 104-114. Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Orbach, G., & Morgan, C. (2002) ‘Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine. 32 pp. 763-782. Prytys, M., Garety, P., Jolley, S., Onwumere, J., & Craig, T. (2011) ‘Implementing the NICE guideline for schizophrenia recommendations for psychological therapies: A qualitative analysis of the attitudes of CMHT staff’. Clinical Psychology and Psychotherapy. 18 pp. 48-59. Read More