Truth Number One:
Equitable access to psychological services across Canada for people living with mental health problems and mental illnesses does not exist! The availability of different forms of treatment varies greatly from place to place.
Truth Number Two:
The services of psychologists are not funded by provincial health insurance plans which make them inaccessible to Canadians with modest incomes or no insurance." This is in spite of the fact that some of the most effective treatments for common mental disorders are psychological ones like cognitive behaviour therapy.
Antipsychotic drugs have proven to be crucial in relieving the psychotic symptoms of schizophrenia and psychosis (hallucinations and delusions). But they are not consistent in relieving the behavioral symptoms of the disorder. Many still have extraordinary difficulty with communication, motivation, self-care, and establishing and maintaining relationships with others. Moreover, because patients with schizophrenia frequently become ill during the critical career-forming years of life (ages 18 to 35), they are less likely to complete the training required for skilled work. As a result, many with schizophrenia not only struggle with thinking and emotional difficulties, but lack social and work skills and experience as well.
It is with these psychological, social and occupational problems that psychological and psychosocial treatments may help most. Numerous forms of psychosocial therapy are available for people with schizophrenia, and most focus on improving the patient’s social functioning — whether in the hospital or community, at home or on the job. Some of these approaches are as follows.
Rehabilitation. This includes a wide array of nonmedical interventions for those with schizophrenia. Rehabilitation programs emphasize social and vocational training to help patients and former patients overcome difficulties in these areas. Programs may include vocational counseling, job training, problem-solving and money management skills, use of public transportation, and social skills training. These approaches are important for the success of the community-centered treatment of schizophrenia, because they provide discharged patients with the skills necessary to lead productive lives outside the sheltered confines of a mental hospital.
Individual psychotherapy. This involves regularly scheduled talks between the patient and a mental health professional such as a psychiatrist, psychologist, psychiatric social worker or nurse. The sessions may focus on current or past problems, experiences, thoughts, feelings or relationships. By sharing experiences with a trained empathic person — talking about their world with someone outside it — individuals with schizophrenia or psychosis may gradually come to understand more about themselves and their problems. They can also learn to sort out the real from the unreal and distorted.
Recent studies indicate that supportive, reality-oriented, individual psychotherapy and cognitive-behavioral approaches that teach coping and problem-solving skills, can be beneficial for outpatients with schizophrenia. However, psychotherapy is not a substitute for antipsychotic medication, and it is most helpful once drug treatment first has relieved a patient’s psychotic symptoms.
Family “psychoeducation,” which includes teaching various coping strategies and problem-solving skills, may help families deal more effectively with their ill relative and may contribute to an improved outcome for the patient.
Very often, patients with schizophrenia are discharged from the hospital into the care of their family; it is important that family members learn all they can about schizophrenia and understand the difficulties and problems associated with the illness. It is also helpful for family members to learn ways to minimize the patient’s chance of relapse — for example, by using different treatment adherence strategies — and to be aware of the various kinds of outpatient and family services available in the period after hospitalization.