Comprehensive Care Not the Norm

Recovery from schizophrenia may be a matter of debate, but researchers agree that the prospects for any degree of recovery improve greatly when patients receive the best treatments available—something that happens far less frequently than it should.

Those best treatments include not only medication, but also proven psychosocial strategies aimed at involving the family, caregivers, and social network to build on strengths rather than focus on pathology.

Courtenay Harding, Ph.D., notes, for instance, that in her long-term follow-up study of deinstitutionalized patients in Vermont (Original article: see story above), those patients benefited from a comprehensive, coordinated biopsychosocial rehabilitation program. “The program became so well known that people came from all over the world to see it,” she said.

But such comprehensive treatment is the exception rather than the rule. Today the rule is “low expectations, reduced collaboration, and system disarray.”

In 1989 the Schizophrenia Patient Outcome Research Team (PORT)—a project of the federal Agency for Healthcare Policy and Research to look at the availability of best practices for a host of common conditions—found that the rates at which patients were offered both medication and proven psychosocial treatment strategies were well below 50 percent.

The PORT found that psychosocial treatments are often prescribed at the point of hospital discharge but that follow-through in the community is low. Moreover, psychosocial treatment varied in conformance rates based on location: Patients in some states are more likely than those of another to be prescribed a vocational intervention and less likely to be prescribed a family intervention or psychotherapy.

“There is a huge shortfall in the intellectual preparedness of the field,” said William Carpenter, M.D., director of the Maryland Psychiatric Research Center. “Patients are very unlikely to get the treatments that we know work.”