Increasing Services for persons with Schizophrenia

1. Increasing Services for persons with Schizophrenia Khadija Andrews 5 Minutes to Change Your Field CEP 532

2. What is Schizophrenia? “ Schizophrenia is a mental disorder characterized by positive symptoms (e.g. hallucinations and delusions), negative symptoms (e.g. avolition and flattened affect), and a decline in social and occupational functioning.” (Twamley, Jeste & Lehman, 2003)

3. When is schizophrenia diagnosed ? Most males become ill between 16 and 25 years old, most females develop symptoms several years later, and the incidence in women is noticeably higher in women after age 30. The average age of onset is 18 in men and 25 in women. (www.schizophrenia.com/szfacts.htm)

4. Schizophrenia Statistics • An estimated 1.2% of the US population has schizophrenia • Ten years after the initial schizophrenic diagnosis 25% have experienced recovery and 25% are much improved and living independently. Another 25% are improved but still require a constant support system. 15% end up hospitalized and, tragically, 10% are dead after 10 years of living with schizophrenia • After 30 years of living with schizophrenia 25% of people are in some form of recovery. 35% of people are improved and lead fairly independent lives. 15% are still in need of extensive support. Only 10% of treated schizophrenic patients are hospitalized. 15% of those who suffer from this mental illness are dead after 30 years

5. Where are the People with Schizophrenia? Approximately: • 6% are homeless or live in shelters • 6% live in jails or prisons • 5% to 6% live in Hospitals • 10% live in Nursing homes • 25% live with a family member • 28% are living independently • 20% live in Supervised Housing (group homes, etc.) (Retrieved from http://www.schizophrenia.com/szfacts.htm)

6. Findings of Research Evidence and research suggests: • Persons with schizophrenia have low levels of employment and vocational functioning for many years after the onset of illness. • Most persons diagnosed with schizophrenia do not have vocational services included in their treatment plans. • Persons who receive services have higher rates of employment. • Many persons with schizophrenia are reluctant to seek employment for fear of losing federal/state aid.

7. Effects of unemployment “ Functional decline in the ability to maintain paid employment can be psychologically and economically devastating to the individual with schizophrenia as well as his/her family members, and it has a negative fiscal impact on the society as a whole.” (Twamley, Jeste & Lehman, 2003)

8. Employment Rates • At least half of people with schizophrenia or a similar mental illness are capable of competitive work. (Warner, 2009) • Less that 15% of persons with schizophrenia are employed; i.e. paid or community-based. • Among persons working age (under 65) fewer than 25% receive vocational services.

9. Disability Benefits & Employment Counselors must: • Be cognizant of the client’s individual needs and situations. • Discuss with client the effect employment will have on the benefits they receive. • Weigh the financial “costs” and “benefits”, along with the client, to determine the best outcome for them. • Also discuss the psychosocial and psychological benefits to being employed.

10. Recommendations Taking into consideration all the statistics discussed earlier; consideration should be given to: • Including vocational services as part of the treatment for persons with schizophrenia. • Providing special programs and services for persons with schizophrenia, that take into consideration their special needs. • Provide vocational counselors with more extensive training in the area of counseling persons with schizophrenia.

11. What should programs entail? USE SITUATIONAL ASSESSMENT Observe and rate the client’s behaviors and attitudes in either actual of simulated work environments. RAPID PLACEMENT Clients who have gained “accelerated” placement and on the job training tend to maintain competitive employment. COMPETITIVE EMPLOYMENT Providing either supported/competitive employment results in more long lasting employment outcomes ONGOING SUPPORT Clients with mental illness are more likely to maintain success if there is continuous support throughout the process.

12. Conclusion Thomas Szasz (1973) said: “The greatest analgesic, soporific, stimulant, tranquilizer, narcotic, and to some extent even antibiotic-in short, the closest thing to a genuine panacea-known to medical science is work.”

13. References Cook, Judith A., & Razzano, Lisa, (2000). Vocation Rehabilitation for Persons with Schizophrenia: Recent Research and Implications for Practice. Schizophrenia Bulletin, 26(1), 87-103. Leff, H. Stephen., Cook, Judith A., Gold, Paul B., et al. (2005).Effects on Job Development and Job Support on Competitive Employment of Persons with Severe Mental Illness. Psychiatric Services, 56(10), 1237-1244. Schizophrenia Facts and Statistics Retrieved from www.schizophrenia.com/szfacts.htm on December 4, 2010. Schizophrenia Statistics Retrieved from www.schizophrenic.com/content/schizophrenia/schizophrenia-statistics on December 4, 2010. Twamley, Elizabeth W., Jeste, Dilip V., Lehman, Anthony F. (2003). Vocational Rehabilitation in Schizophrenia and Other Psychotic Disorders: A Literature Review and Meta-Analysis of Randomized Controlles Trials. British Journal of Nervous and Mental Disease, 191(8), 515-523. Warner, Richard (2009). The Last Word: Why work? Disincentives to Employment in the Benefits System. CrossCurrents. Retrieved from www.camh.net/Publications/Cross_Currents/Summer_2009/lastword_crcusummer09.html on December 4, 2010