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Improving Care for Patients with Serious Mental Illness
Fall 1999
Recent studies indicate that many patients with schizophrenia receive pooror inadequate care. Many patients with schizophrenia have failed to benefit from newer medications and improvements in psychosocial treatments. In some cases this failure is due to the nature of the patient's illness, as there are still patients who do not respond to all available medications. Others with severe cognitive impairments may be unable to benefit from the innovative psychosocial treatments that have been developed during the 1990's. For these individuals, the severity of their illness is the obstacle that stands in the way of improvement. For others, mental health care systems have failed to make the best treatments available. Investigators in our MIRECC, along with other researchers are addressing the obstacles preventing patients with schizophrenia from receiving the best available treatments.
Initial resistance to the substantially higher costs of the newer antipsychotic medications prevented their acceptance into general psychiatric treatment protocols. However, a body of evidence gathered since their introduction, indicates that these agents can actually reduce the overall cost of treating schizophrenia by decreasing the need for inpatient hospitalization. Other evidence indicates that these drugs are much less likely to cause extrapyramidal side effects and may reduce the risk of tardive dyskinesia. Although formulary restrictions and a resistance by some payers interfere with the prescribing of newer drugs, these obstacles are gradually fading.
Studies indicate that treatments that have demonstrated their effectiveness in research settings are frequently unavailable to patients with schizophrenia who are treated in the community. These include treatments such as vocational rehabilitation or Assertive Community Treatment (ACT), a form of intensive case management, which is cost effective for many patients. Dr. Alexander Young from this MIRECC observed the treatment of schizophrenia in two public mental health clinics. In both settings, a high proportion of patients received poor quality medication treatment. Poor quality care often consisted of patients continuing to receive medication without adequate monitoring of effectiveness or side effects. In addition, a majority of patients received inadequate psychosocial treatment.
It is discouraging that the innovations in treatment that emerged during the 1990's are still not reaching many patients with schizophrenia. This issue of the newsletter addresses some of the challenges clinicians and consumers face in fixing this system.
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