SEVERE MENTAL ILLNESS: SEPARATING FACT FROM FICTION

SUMMARY OF MEDIA EVENT ON 6 OCTOBER @ RSM

Bold tabloid headlines such as “Axe wielding psycho murders in high street” are too often used to describe mental illness to the public. This is regrettable and fails to help the public understand the reality for the majority of people living with mental illness.

Mental ill health is experienced by 1 in 4 of the population and 1 in 100 live with schizophrenia, costing the UK £77.4 billion a year, but most people affected can enjoy good quality of life with good treatment and support.

Severe mental illness includes schizophrenia and bi-polar disorder, also known as manic depression. Severe mental illness is second only to cardiovascular disease in Europe and presents a major public health challenge. People with schizophrenia can experience delusions and hallucinations and many withdraw from day to day social contact. In bi-polar disorder people experience profound mood swings between heightened elation and crippling depression, often accompanied by feelings of worthlessness. The causes of serious mental illness are unknown, but experts suggest that genetic factors and social and environmental factors may be important.

Schizophrenia is the most common form of severe mental illness and popular mythology and negative media coverage support a stereotypical view that people with the disorder are a danger to the public. The truth is that people living with the disorder are more likely to harm themselves than others. Studies suggest that 10% of people affected commit suicide. The other challenge in schizophrenia is to assist people with the disorder to keep in touch with supportive services, as around 50% are unlikely to do so, often leading to relapse and expensive and disruptive admissions to hospital.

To prevent relapse good services attempt to balance sound risk management plans, based on individual assessment, which fully involve the patient, family members and carers. This must also include open discussion and informed choice about medication, according to Dr. Elizabeth Walsh, a consultant in forensic psychiatry with the South London and Maudsley NHS Trust. Dr. Walsh points out that 8 out 10 people with schizophrenia experience relapse in the first 5 years of the disorder by not taking medicines and losing contact with support. A recent survey of UK psychiatrists by SANE, a mental health charity, suggests that 65% of people stopped taking their medication when they felt better.

Dr. Walsh likens schizophrenia to any other long-term health condition such as diabetes and asthma. Patient and family education are just as crucial in schizophrenia as in any other area of health, and helping people to see their experience in these terms is less stigmatising and damaging.

Dr. Walsh is keen to emphasize the value of engaging people with schizophrenia in understanding the value of medication and other talking therapies, alongside other important issues in their lives, like social networks, housing, friendship and employment.  It is important that patients and families understand that life can be good - you can help them to spot early warning signs of relapse and support people to become better equipped to live with their disorder more effectively.

Dr. Walsh is clear that good management of severe mental illness requires a holistic approach, including biological treatment, e.g., medication, psychological support and crucially, social support in the community. Dr. Walsh also points out that the experience of hallucinations, such as hearing voices, is not proven to be a key factor in mentally ill people who commit acts of violence. Delusional thoughts of a paranoid nature and serious substance misuse, like taking cannabis, are more important factors in those rare cases where mentally ill people become a threat to the public.

Emily Brown works with service users with the mental health charity Together, formerly known as the Mental Aftercare Association. Emily points out the importance of people living with enduring mental health problems having the same opportunities in life as any other citizen. Together provide over 100 services to such people, supporting over 2500 individuals. Together offer support to people in seeking a better quality of life, including education and employment opportunities.

Emily experienced problems herself in her twenties and recalls being told by a doctor that she would never be able to hold down a job. This was a devastating experience for her. She feels that stigma related to mental illness amongst the public and low expectations amongst some health professionals really do not help, and people need to remember that mental health and disability represent a minority that any of us might join at some point in our lives.

Emily stresses that the language used to describe people with mental illness can be debilitating. People do not like to be seen as a diagnostic label and need respect for other facets of their lives, she believes, and stresses the importance of individual choice in treatment and ongoing care. Together teach many people with mental illness self management skills, allowing people to take things at a pace that is comfortable for them in a safe and supportive environment.

Listening to the experiences of people living with schizophrenia is crucial to understanding the disorder. Sandra Lawman is secretary to the special trustees of the South London and Maudsley NHS Trust and has lived with schizophrenia for many years. Sandra became unwell as a young woman in Japan , where she was teaching after finishing university. On her return she was prescribed injections of anti-psychotic medications, became well and commenced work as an accountant. As she felt well she ceased taking medication and subsequently lost her job.

She eventually settled on tablets but observed that they left her so tired all the time, she had to go to the loo for a sleep during her lunch breaks. In 2002 she was able to take a newer anti-psychotic, which transformed her life. The tiredness abated and she felt much more ‘herself’. Sandra now holds a senior job and has served successfully as an elected councillor in local Government. In addition, she has campaigned with various voluntary organisations in the mental health sector, and has recently been nominated to serve as a UK representative on the international board of the Clubhouse movement, based in New York .

Sandra feels that too often service users are seen as a diagnostic label and treated in a patronising manner and as children. She also points out that the incidence of murder amongst people living with mental health issues is no greater than that in the general population. Sandra provides a powerful example of somebody who manages her experiences well and challenges the stereotypical image of people who live with the experience of schizophrenia.

Dr. Ray Rowden, Director, Mental Health International Development and Associate, The Healthcare Commission.

For more information about schizophrenia please visit www.oneinonehundred.co.uk or call 0800 587 1153 for a free information pack.

(12/10/05)