Britain condemned for "mad house" schizophrenia care system

Wed Nov 14, 2012 3:24am EST

* Emphasis on risk of violence, security too great - report
* Schizophrenia affects around 24 million people worldwide

* UK urged to learn from Swiss, Dutch patient care

By Kate Kelland

LONDON, Nov 14 (Reuters) - Patients with schizophrenia in Britain are too often locked up in "mad house" institutions that are more likely to make them worse than better, mental health experts said on Wednesday.

In a damning report on how people with the severe mental illness are cared for in Britain, the experts said there were "catastrophic failings" in treatment and described "shameful" standards of care on some mental health wards.

The problems arise and are exacerbated in part by public misconceptions that schizophrenics are crazy, violent people who pose a risk to society, they said.

"In this country we've become preoccupied with the idea that schizophrenia means a madman with an axe," Robin Murray, a professor of psychiatric research at Britain's Institute of Psychiatry, told reporters as the report was published.

The reality, he said, was that the vast majority of people with schizophrenia were not violent and were in fact more likely to be victims of attacks than to lash out at others.

He said Britain could learn a lot from countries such as Switzerland, the Netherlands and Denmark, where health systems focused on getting patients with schizophrenia into calm, caring environments, rather than spending limited funds on unnecessary security and less appropriate treatment.

Schizophrenia affects around 24 million people globally, according to the World Health Organisation (WHO). Patients can suffer from psychotic experiences such as delusions, paranoia, or hearing voices.

Although there is no cure and relatively little is known about its causes, there are many medicines and therapies that can treat some of the most serious symptoms.

The WHO estimates the costs of treating someone with chronic schizophrenia can be as low as $2 a month. But across the world, including in developed countries like Britain, many patients have limited access to treatment. The WHO says more than half of all schizophrenia sufferers do not get appropriate care.



"ABANDONED ILLNESS"

The British report, which described schizophrenia as "the abandoned illness", found that nursing and other healthcare staff working in schizophrenia services in the country's state-funded National Health Service were often demoralised and "burnt out" and that "pessimism pervades the system".

It was written by a panel of mental health specialists known as the Schizophrenia Commission who heard evidence in person from 80 experts and people affected by the illness, and from 2,500 more who gave evidence online.

It said mental health hospital wards were often such appalling places they made patients worse rather than better.

"If you develop psychosis and your mind is disturbed ... and you think people are against you, you'd want to be admitted for a period of care and respite and calm and some gentle pharmacological and psychological treatments," said Murray.

"But in fact that doesn't happen. Here, you get admitted to a mad house. And some of these places are very anti-therapeutic - not only for patients but also for staff. No sensible person would want to be admitted to one of these places."

Paul Jenkins, chief executive of the charity Rethink Mental Illness, said it was a "scandal" that in 2012 people with schizophrenia were dying 15 to 20 years earlier than the general population and that only 7 percent were able to get a job.

"Too many people are falling through the gaps in the system and ending up in prison or homeless," he said.

An analysis by researchers at the London School of Economics (LSE), which formed part of the report, estimated schizophrenia costs the UK 11.8 billion pounds ($18.7 billion) a year in "societal" costs including care and treatment, loss of employment, tax revenue, unpaid care and premature deaths.

Martin Knapp, professor of social policy at LSE who carried out the analysis, said too much was spent on expensive types of care - secure units - and not enough on trying to prevent schizophrenia and provide community support for patients.

Marjorie Wallace, chief executive of mental health charity SANE, said: "The real scandal is that despite all the pledges of successive governments, (schizophrenia) patients are daily being deprived of hospital beds, except on remaining wards which can be so shabby and chaotic they make their conditions worse." ($1 = 0.6302 British pounds) (Reporting by Kate Kelland; Editing by Pravin Char)