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NICE Guidance Recovery [63]Helping you recoverServices that can helpIn the long term, there are a number of issues that a person with schizophrenia has to deal with over and above the problems other people have to deal with. Once you have developed schizophrenia:
The services and mental health teams that can help you include your GP and the primary care team, community mental health teams, assertive outreach teams, crisis resolution and home treatment teams and early intervention teams. Staying in touch with services is very important so that you can get the treatments that will help. Through these teams, you can get services and treatments that have been proven to be effective. It is also important for the teams to keep an eye on your physical and mental health, and to provide ongoing help and support, including during a crisis. The aim of treatment in the long term is to promote your recovery by:
How your mental health team can help (secondary care)Assessing your needs and organising your careIf you are seen by a mental health team (most people with schizophrenia are), your care will be co-ordinated through the Care Programme Approach (CPA). This means you will have a named ‘care co-ordinator’ who will make sure that you and your carers and all the services and people involved in your care know what they should be doing. Your care co-ordinator and mental health team will make sure they know about your needs, and plan your treatment in detail with you. They should develop a care plan based upon an assessment of all your social, work, accommodation, financial, medical, psychological and cultural needs. If you don’t see your GP or don’t wish to, your psychiatrists could also do regular physical checks with you – they’ll let your GP know that they are doing so. Your care co-ordinator and mental health team should decide with you how often these full assessments need to be done and write this in your notes. If you are on ‘enhanced CPA’ (usually because you need a lot of help) you may have full assessments every year. Your carers/family can play an important part in helping your recovery.They also need help, especially in times of crisis. If you agree, the team who help you should contact your carers and provide information, support and develop a carer care plan to record the help they need. The teams that will help, now and in the futureAt the moment, most help will come from your community mental health team (CMHT for short). This will continue to be the case in Wales . However, in England other teams are being developed to give you extra help should you need it. For example, if you have had several breakdowns, have been on the wards a lot, have poor housing or are homeless, you should have most of your care provided by an assertive outreach team. If you have only recently had your first breakdown, your care should be provided through an early intervention team (who specialise in working with people during and for 3 years after their first breakdown). If the team caring for you are unable to meet all your needs during a crisis, they may ask a crisis resolution and home treatment team (CRHTT for short) to help provide support. If the CRHTT also can’t give you enough support, they may refer you to an acute day hospital. After a crisis, you will usually go back to your original team. Psychological treatments to help recoveryCBT and family work, when given with antipsychotic medication, can help reduce the number of breakdowns you have, more than just medicines alone. They probably won’t stop breakdowns altogether, but they can help them happen less often. At the moment they are not widely available, but this will change over the next few years. Cognitive behavioural therapy (CBT)Cognitive behavioural therapy can help reduce the chance of another breakdown. It is also particularly useful if you have symptoms that won’t go away and are troubling to you. CBT is also helpful if you are having trouble accepting that you have schizophrenia (sometimes called ‘lack of insight’), and it may help if you tend not to take your medicine properly (sometimes called ‘poor compliance’). If you have CBT, it is better to have longer treatments than shorter ones. For it to make a difference, you should have CBT treatment for more than 6 months, meeting for more than ten treatment sessions. If you are offered shorter treatments, the CBT may help you feel a bit less depressed, but it is unlikely to help you with other symptoms. Family workBecause schizophrenia affects both the individual and his or her family or partners, working with the family or partner can be very helpful to everyone. If you live with or are in close contact with your family (including carers and partners), family work can also reduce the chance of you having further breakdowns. Family work is especially helpful for people who have had a breakdown in the last 3 months or are at risk of breaking down (say, because things have gone particularly badly, or the person has had a lot of breakdowns over recent years). It is also helpful for people who have symptoms, such as voices or strange thoughts, that remain after a breakdown is over. Again, longer treatments are better than shorter ones. Family work should last for more than 6 months and include more than ten sessions of treatment. Family work also works better if you go for treatment with your family. Sometimes, though, it’s better for your family to receive help separately. You’ll need to discuss this with the team who are treating you. Family work can be given to single families on their own or to a group of families. You and your family may prefer to have family treatment on your own. Although counselling doesn’t stop breakdowns or change symptoms, you may want to spend some time talking to a mental health specialist and your preference for this should be respected by your mental health team, especially if CBT and family therapy are not easily available. Over time, CBT and family therapy will be much more widely accessible.
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