Understanding Community Care: History, Features, and Evaluation for Schizophrenia Patients

1. Learning Objectives • ALL will understand the history of community care • MOST will be able to explain the key features of community care • SOME will evaluate the worth of community care for patients with schizophrenia through a piece of psychological research DO NOW: read through the BBC news article and produce a mini timeline of how community care has come to be what it is today

2. DO NOW FEEDBACK: TIMELINE SUMMARY COMMUNITY CARE: caring for, and treating, patients in the community What do we mean by the ‘community’ where will the person be?

3. PAIRWORK • We are going to consider the relative advantages and disadvantages for the patient of HOSPITALISATION versus CARE IN THE COMMUNITY VS

4. PAIRWORK - PLAN • Each pair has a basic description of what happens in both hospitalisation and community care • YOU are going to decide, as a pair, what are the advantages and disadvantages of these treatment options for the patient • NEXT you will ANALYSE which treatment option would be the best for a variety of patients • FINALLY you will look at some new ‘wildcard’ information and see if this changes your views on the treatment options

5. COMMUNITY CARE: basic info • Community care aims to give continued support to the patient outside the hospital ward • Case management – a way of tailoring help to each individual’s needs. A patient will be allocated to named key worker (CPN or community psychiatric nurse) who has to assess and co-ordinate care • Occupational therapists can give advice about building social skills • Patient can attend day clinics and day centres within the community • Patients may be provided with supported accommodation where they have their own bedsit, but a member of staff also lives on the premises

6. HOSPITALISATION: basic info • The patient will be on a ward specifically for mental health problems. The ward will be run to a set routine in terms of meal times etc • The patient is closely observed in terms of behaviour and receives regular medication from trained medical staff • A person with schizophrenia may choose to enter a hospital if she feels her symptoms are out of control. There are also situations when a person with schizophrenia may be forced to go to the hospital or sectioned. These are: • Violence to others. If a person with schizophrenia threatens others, he can be committed. However, only a small percentage of people with schizophrenia are violent. • Suicide threat. For a hospital to take the threat of suicide seriously, the person issuing it needs to have a plan, and the means to carry out the plan.

7. Patient Examples • Dave is diagnosed with paranoid schizophrenia. He frequently hears voices which state that they will kill him unless he does as they say. The voices recently asked him to kill his father. • Joe is diagnosed with residual schizophrenia. Joe lost his job during a more active phase of the disorder and has no family. He has had problems in the past with remembering to take his medication which has led to his schizophrenia relapsing • Sam is diagnosed with disorganised schizophrenia. Sometimes her speech is jumbled and she has problems expressing emotion. Sam is 18 and has a very loving family.

8. Patient Example 1: Dave • Dave is diagnosed with paranoid schizophrenia. He frequently hears voices which state that they will kill him unless he does as they say. The voices recently asked him to kill his father.

9. Patient Example 2: Joe • Joe is diagnosed with residual schizophrenia. Joe lost his job during a more active phase of the disorder and has no family. He has had problems in the past with remembering to take his medication which has led to his schizophrenia relapsing

10. Patient Example 3: Sam • Sam is diagnosed with disorganised schizophrenia. Sometimes her speech is jumbled and she has problems expressing emotion. Sam is 18 and has a very loving family.

11. WILDCARD TIME – does this change your decision!? • HOSPITALISATION Hospital wards provides very little information about how to survive and fend for your self in the outside world Hospitals can be seen as places which increase some of the symptoms of schizophrenia • Institutionalisation does have some benefits: • A controlled environment allows for close monitoring, support and appropriate treatment • It can prevent harm to the self and others

12. WILDCARD TIME – does this change your decision!? POLITICS Community care requires large financial investment if community care is to be effective: the current government have made many cuts to the care system which means for some this is not possible STEIN AND TEST’S RESEARCH However, services are often patchy depending on available funding in local areas and the burden on families increases Christopher Clunis was jailed indefinitely after stabbing Jonathan Zito, 27, through the eye at Finsbury Park station in December 1992. The case caused outrage when it was revealed that Clunis, now 45, who had a history of violent behaviour, had been released under the controversial 'care in the community' programme just weeks before the killing. Eight days before the attack, Clunis, who had stopped taking his medication, was found wandering the streets with a screwdriver and breadknife, threatening children. Some patients simply ‘slip through the net’ and do not receive the care and attention that they need, with very negative consequences for the individual and others e.g. the murder of Jonathan Zito

13. Until the 1960s patients were hospitalised – advances in drug treatments means the incidences of long-term care has been significantly reduced Hospitals can be seen as places which increase some of the symptoms of schizophrenia Hospital wards provides very little information about how to survive and fend for your self in the outside world Many mental hospitals have now been replaced by community care programmes Community care • Institutionalisation does have some benefits: • A controlled environment allows for close monitoring, support and appropriate treatment • It can prevent harm to the self and others Community care aims to give continued support to the patient outside the hospital ward Case management – a way of tailoring help to each individual’s needs Occupational therapists can give advice about building social skills However, services are often patchy depending on available funding in local areas and the burden on families increases A patient will be allocated to named key worker (CPN) who has to assess and co-ordinate care Patient can attend day clinics and day centres within the community Some patients simply ‘slip through the net’ and do not receive the care and attention that they need, with very negative consequences for the individual and others e.g. the murder of Jonathan Zito Patients may be provided with supported accommodation where they have their own bedsit, but a member of staff also lives on the premises

14. Learning Objectives • ALL will understand the history of community care • MOST will be able to explain the key features of community care • SOME will evaluate the worth of community care for patients with schizophrenia through a piece of psychological research ‘The most suitable treatment for schizophrenia is medication and this treatment should take place in an institution.’ Discuss this view (12 marks)

15. Answer the following question Briefly evaluate the role of community care in the treatment of schizophrenia (4 marks)