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.
