Schizophrenia: Cautious Optimism in Service Provision
Kingdon brings a welcome air of optimism to the management of
schizophrenia (1). Advances in psychosocial management have been made but
have not been implemented due to funding restrictions. Kingdon highlights
new models of service delivery such as home treatment and early
intervention teams in reducing admissions. These may be best suited to
those patients with a relapsing and remitting illness who only require
brief admissions. Such services are expensive and in order to fund them
commissioners and providers will need to divert resources from existing
services, including longer stay rehabilitation units. Kingdon himself
states that "the programme to close mental hospitals is near completion in
the United Kinngdom."
The calls for an end to stigma and a greater emphasis on social
inclusion and recovery are laudable. However, when it comes to service
provision, an exclusively recovery based model is flawed. Trusts with
limited access to longer stay in patient beds have high rates of "new long
stay patients" on acute admission wards. Up to 80% of these have diagnoses
of schizophrenia or schizoaffective disorder (2). These patients do not
fulfil services' expectations of recovery. As a result they and the teams
that care for them are likely to experience increased stigma, made
manifest by the use of perjorative terms such as "bed blockers". The
abscence of local beds is leading to the growing phenomenon of
reinstitutionalisation in private sector units. These units are costly and
of uncertain quality. They are also usually far removed from family and
friends, which arguably compounds an already profound sense of alienation
which is characteristic of the illness itself.
Kingdon concludes that a more optimistic outlook for schizophrenia is
warranted based on a more benign course in some patients. Such optimism is
welcome, but we would urge commissioners and providers at a local level
not to forget those with more severe and chronic illnesses who do not fit
neatly into the recovery model.
1.) Kingdon, D. Psychological and social interventions for
schizophrenia. BMJ 2006;333: 212-3
2.) Cowan C, Walker P,. New long stay patients in a psychiatric
admission ward setting. Psychiatric Bulletin 2005; 29: 452-454
Rapid Response:
Schizophrenia: Cautious Optimism in Service Provision
Kingdon brings a welcome air of optimism to the management of
schizophrenia (1). Advances in psychosocial management have been made but
have not been implemented due to funding restrictions. Kingdon highlights
new models of service delivery such as home treatment and early
intervention teams in reducing admissions. These may be best suited to
those patients with a relapsing and remitting illness who only require
brief admissions. Such services are expensive and in order to fund them
commissioners and providers will need to divert resources from existing
services, including longer stay rehabilitation units. Kingdon himself
states that "the programme to close mental hospitals is near completion in
the United Kinngdom."
The calls for an end to stigma and a greater emphasis on social
inclusion and recovery are laudable. However, when it comes to service
provision, an exclusively recovery based model is flawed. Trusts with
limited access to longer stay in patient beds have high rates of "new long
stay patients" on acute admission wards. Up to 80% of these have diagnoses
of schizophrenia or schizoaffective disorder (2). These patients do not
fulfil services' expectations of recovery. As a result they and the teams
that care for them are likely to experience increased stigma, made
manifest by the use of perjorative terms such as "bed blockers". The
abscence of local beds is leading to the growing phenomenon of
reinstitutionalisation in private sector units. These units are costly and
of uncertain quality. They are also usually far removed from family and
friends, which arguably compounds an already profound sense of alienation
which is characteristic of the illness itself.
Kingdon concludes that a more optimistic outlook for schizophrenia is
warranted based on a more benign course in some patients. Such optimism is
welcome, but we would urge commissioners and providers at a local level
not to forget those with more severe and chronic illnesses who do not fit
neatly into the recovery model.
1.) Kingdon, D. Psychological and social interventions for
schizophrenia. BMJ 2006;333: 212-3
2.) Cowan C, Walker P,. New long stay patients in a psychiatric
admission ward setting. Psychiatric Bulletin 2005; 29: 452-454
Competing interests:
None declared
Competing interests: No competing interests