Though schizophrenia is a disabling and lifelong illness, many people with this condition are able to function well with the help of family and regular ongoing care from their treating team. In terms of the actual problem, they have experiences of hearing human voices or seeing things that are not there and have suspicious beliefs towards others without a rational reason. These two main experiences are successively called hallucinations and delusions, also termed as positive symptoms.
For the last two decades, there has been a transition in the treatment provided at hospitals, to the treatment given in the community that includes home visits by mental healthcare staff.
The treating team involving family members must prepare a care plan that includes details of follow-up care post-hospital discharge. Those needing long-term care will have to be tended by a mental health nurse as care coordinators, supervised by a psychiatrist to ensure that a care plan is followed.
Outreach visits to home are being done in few places.
Such service initiatives where treatment care is provided at patients’ residence should be expanded all over India to help persons with severe and chronic illness such as schizophrenia.
Care package during home visits also involves monitoring of side-effects of medication and reassurance to family members. For the so-called negative symptoms, such as reduced initiative or drive, not able to enjoy or socialise, counselling work and encouraging them to take care of their personal hygiene is usually done. If the patient shows early warning signs, then the nurse coordinator can decide and pay more frequent visits with or without medication changes by the psychiatrist. Frequent unwilling hospitalisations can largely be avoided by ensuring they take medications regularly. Depot injections given once in every two to four weeks is also an option. Consulting with the same treating psychiatrist, if felt suitable, improves doctor-patient relationship too.
(The author is consultant psychiatrist, Bengaluru)