Schizophrenia is generally regarded as one of the most significant illnesses treated by mental health services. Its significance lies in the profound impact of the illness on sufferers and their families and friends. The illness is long term and treatment is usually ongoing. The person with schizophrenia may suffer relapses in the condition if medication is not continued.

What is Schizophrenia?
Schizophrenia is a disorder of the brain that interferes with thinking and judgement of reality, and may also affect a person’s mood, motivation and ability to relate to others. The causes are not fully understood but there are clear genetic factors coupled with triggers in the person’s environment such as personal stress or substance abuse. These circumstances can produce changes in brain chemistry, which give rise to the symptoms. The effectiveness of treatment varies from person to person. There is no “cure” as such, but medication and therapy aim to control or reduce symptoms. For about 50% of sufferers, they can, with support, maintain relatively normal lives in the community and have productive working careers and family lives. Others may experience episodes of relapse where severe symptoms re-emerge and may require periods of hospitalisation for a few weeks, disrupting their community adjustment.

Schizophrenia is a true illness with biochemical roots. There is no evidence that it results from poor parenting as was once believed.

Who can suffer from schizophrenia?
Schizophrenia typically first emerges in young adults. Both males and females are affected equally. Schizophrenia is diagnosed all over the world in all cultures and races. It is also present in all social class categories but there is some evidence that the inner-city poor are more vulnerable. The world incidence has been stable at about 1 in 100 for the past several decades. From the available data it is concluded that the Bermuda incidence rate is similar (1%). The risk is higher if others in the same family have had the illness.

Symptoms of schizophrenia
Schizophrenia can present with a wide variety of symptoms, not all of which are experienced by every individual. The first of three clusters of symptoms are the “psychotic” symptoms including delusions (false beliefs) and hallucinations (usually voices). These symptoms typically cause the greatest distress to the patient, who may feel threatened by people he believes are plotting against him. There are sometimes feelings of being controlled by others or of being capable of controlling other’s thoughts. The ”disorganised” symptoms include confused thinking and odd speech. Thoughts tend to be jumbled and people have difficultly in understanding the patient. The “negative” symptoms include lack of emotional expression, loss of interest or pleasure, and apathy. The loss of self-care skills and social withdrawal also fall in this category. This rather passive profile is much more common in our clients than the misleading Hollywood depiction of violence in people with schizophrenia.

Antipsychotic medications form the first line of treatment. Significant improvements have been witnessed in recent years and modern (“atypical”) antipsychotics produce fewer and less severe side effects than traditional medications. This improvement in side effects has promoted greater adherence to prescriptions.

Psychosocial treatments assist in reinstating life skills. Emphasis is placed on social skills, activities of daily living, and vocational skills. A core goal of rehabilitation services is engagement of clients in meaningful activity such as “sheltered work” placements.

Individual and group psychological therapies are also employed to aid in symptom control, assist adjustment to novel circumstances, and helping the patient to identify and avoid relapse triggers.

Success in treatment depends on a supportive network of family, employer, friends, and clinical staff assisting the individual to achieve the greatest independence possible.

Met and unmet needs
People with schizophrenia in Bermuda are fortunate in having access to the full range of clinical services and professionals found elsewhere. More challenging is their access to affordable housing and suitable employment.

In cases where significant family support is not available, they often have difficulty in maintaining themselves. Recent changes in Financial Assistance regulations and reduced availability of Salvation Army Shelter beds pose further threats to them. These limitations in community resources contribute directly to patterns of homelessness, substance misuse, and petty crime for a subgroup of people with schizophrenia. This group then contribute to keeping our Courts, Prisons and hospital beds occupied on a rotating basis in a cycle, which is detrimental to the community and the individual.

In the past there has been active support from the Bermuda Schizophrenia Society and the Bermuda Mental Health Foundation and other charities. In recent years, this group of clients has lacked a vocal community advocate to press for better conditions. The professionals involved have restrictions on their ability to comment on politically sensitive issues. The need for revitalised advocacy support from the community is apparent.

How to get help
The first source of assistance for emerging symptoms of mental illness is usually the family doctor. After a screening assessment for other (physical) causes for the symptoms, the GP will normally refer to the Acute Community Health Clinic for psychiatric assessment and treatment. Once a diagnosis is made, the patient and his family will be offered further education on the nature of the illness and its treatments.

Family members and carers often benefit from the mutual support provided in the weekly Family Support Group. If a wider range of services is required, the patient may be referred on to the Community Rehabilitation services.

For further information on the illness or services available contact the Community Mental Health Clinic on 239-2261 or 236-5208.

Jeremy Lodge completed his postgraduate training in Britain and has been with Bermuda Hospitals Board for 26 years. He is employed as a clinical psychologist working with adults in both the Acute Mental Health Programme and the Rehabilitation Programme at St. Brendan´s Hospital.


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