Fund schizophrenia care says Fels

The deinstitutionalisation of mental healthcare in Australia may have relieved the Government of big spending obligations, but the community is carrying the weight of unmet need.

The current issue of the Medical Journal of Australia describes one family's fight to get appropriate care for their daughter, who has schizophrenia.

Through a moving account of his daughter's illness, Professor Allan Fels appeals to governments to realistically fund the diagnosis, care and treatment of people suffering from schizophrenia.

Thirty-one-ear-old Isabella Fels was diagnosed with the disease six years ago, after years of confusing and sometimes bizarre behaviour.

After attempts to live independently of her family, Isabella now lives at home, receives treatment from a psychiatrist, and takes medication, which generally relieves her psychotic symptoms.

"As an illness which extends over an entire lifetime, it has enormous personal, family, social and economic ramifications," Professor Fels said.

"One effect of deinstitutionalising those with mental illness since the 1980s has been the greater burden on families," he said.

"Families that try to care need substantial backups, but these are often lacking.

"An attempt by Isabella to live away from home with others, in a house with mental health workers present from 9am to 5pm on weekdays, did not work.

"She has underdeveloped living skills, and her illness is such that she could not live by herself - she basically depends upon family care.

"More programs of organised recreation and activity are needed.

"In Isabella's case these would include, besides occupational therapy, activities such as reading together, writing together, general education on current affairs and general knowledge, as well as vocational training, counselling, help with developing living skills, structuring the day, managing diet and physical exercise, and in obtaining part-time work," he said.

While acknowledging that some support services are effective, Professor Fels was critical of many services.

"In some instances, we experienced problems that seemed to stem partly from a failure to adequately include the family - the long-term primary carers with the best understanding of the person and their illness - in management," he said.

"At other times, we experienced demeaning and dispassionate attitudes from some mental health workers.

"We encountered some social workers with an attachment to inappropriate or ill judged notions of independence and personal freedom for the person with schizophrenia.

"This has sometimes been based on a superficial understanding of that person's circumstances, reinforced by short-term involvement caused by high rates of staff turnover, Professor Fels said.

He said there is growing evidence that early treatment might help alleviate the illness.

Professor Fels said as a society we should try to overcome the stigma of schizophrenia and he called on GPs, school teachers and counsellors to watch for early signs of the illness.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT:           Professor Allan Fels, 02 6285 6170

                         Judith Tokley, AMA, 0408 824 306