The estimated 12-month frequency of individuals living with a psychotic disorder translated to approximately 43,815 individuals in Australia1. Aged between 18 and 64 years, this number represents the number of people potentially seeking support from mental health professionals in any given month.

With this volume of people suffering comes an urgency for the general public, alongside allied health professional, to better understand the effects living with a psychotic disorder such as schizophrenia entails.

What are the social, health and economical effects of living with Schizophrenia?  

People with severe and persistent mental distress, such as schizophrenia, are more likely to experience negative discriminatory attitudes and behaviours than people without a diagnosis2.

Population-based studies in the field of serious mental distress have found associations between adversity, disadvantage and a lived experience of schizophrenia3. Disadvantaged by factors such as trauma, unstable housing, poor financial circumstances, limited social and community supports, social isolation and discrimination4. One study found 85% of surveyed individuals experiencing mental distress were accessing a government pension as their main income, one in five participants had difficulty with literacy, and one third had left school with no qualification5.

Furthermore, 47% of participants had experienced negative forms of discrimination such as making or keeping friends, finding employment and discrimination in intimate and sexual relationships; 72% felt the need to conceal their diagnosis to avoid anticipated discrimination. And after experiencing discrimination individuals described withdrawing from all social interactions, to preserve their sense of self-esteem.

What are some of the effects of discrimination for those suffering from Schizophrenia face? 

The experience of discrimination occurs at many levels, from internal anticipatory anxiety, discrimination from strangers, negative representations in the media, to discrimination whilst accessing health care such as primary and mental health care. People living with schizophrenia are less likely to receive standard treatment for physical issues and thus have a higher prevalence of morbidity and mortality than the general population6. Furthermore, people with a diagnosis of schizophrenia are less likely to receive psychological therapies, from mental health professionals, such as cognitive-behavioural therapy for schizophrenia/psychosis (CBT-p)7. It is this confluence of divergent person, provider and system factors that contribute to individuals concerns about accessing mainstream health services8.

What is the association between schizophrenia and dangerous behaviour, and how does this mislead the public? 

One such discriminatory attitude is that all people with schizophrenia are dangerous9. Having attributed a person’s behaviour as dangerous people will generally experience fear and become avoidant of the feared person(s). The association between danger and schizophrenia is a worldwide issue, with approximately half of the news stories (TV and print) about schizophrenia in Italy, New Zealand, the USA and Canada linking schizophrenia with danger, homicide or violence10. Following this type of news story, there is an overall increase in negative attitudes towards and the desire for social distance from people with schizophrenia.

Studies have also shown an association between the desire for social distance and attitudes of social restrictiveness. Those with an attitude of social restriction propose that people with schizophrenia are dangerous and unpredictable and thus their freedom and autonomy should be restricted11. Socially restrictive attitudes are highly predictive of discriminatory and negative attitudes.

In addition, an authoritarian attitude suggests that people with schizophrenia are different and cannot care for themselves12. These attitudes have been found to influence the way that individuals perceive, and subsequently interact, with people with schizophrenia13.

What is being done to reduce the stigma around schizophrenia? 

Attempting to combat prejudice and negative attitudes, anti-stigma campaigns have created mental health literacy amongst the public, to help enable better recognition of mental disorders14. Campaigns often utilise an attribution-based approach to explaining mental distress. Attributions provide a knowledge structure for people to categorise information and generate expectations of individuals belonging to the group15. For example, attributing schizophrenia as an illness like any other, the expectation generated by this attribution is that schizophrenia is a biological illness like cancer16.

The primary attributions associated with schizophrenia are genetic or inherited factors and a chemical imbalance17. Such factors have been termed biogenetic causal attributions. Biogenetic attributions do not necessarily result in more helpful attitudes from the public towards people experiencing schizophrenia18, and health professionals with strong biogenetic aetiological beliefs were unlikely to recommend psychological therapy19.

How do Allied Health professionals respond to schizophrenia, and what approach is commonly taken? 

It would be reasonable to assume that negative attitudes and biases found amongst the public would not exist within the mental health workforce. However, mental health workers such as psychiatrists, nurses, mental health nurses, GP’s and psychologists have been shown to share these negative attitudes20. The overarching model generally promoted in clinical training and practice is the biomedical model of illness. Authors have suggested that at the core, this model minimises the psychosocial factors and instead proposes that psychological phenomena can be reduced to biological causes21.

In contrast, the biopsychosocial (BPS) model provides a more holistic approach to understanding the patient’s subjective experiences of psychological disorders or distress22. The BPS enables an easier transition towards a multidisciplinary approach and thus a more comprehensive understanding and better client outcomes23. Critics of the BPS approach state that the inclusion of multiple subjective factors (biological, psychological and social) is unscientific24. Despite the critics, a BPS approach to health determinates increases practitioners focus on client-clinician rapport and a working relationship, whilst also integrating evidence-based knowledge. Studies have shown that clinicians that apply a BPS approach generally express more helpful and positive attitudes towards individuals living with mental distress25.

One study found that mental health professionals who endorsed a BPS framework were more likely to have attitudes reflecting social integration and community based mental health support. Other factors associated with positive attitudes include prior contact with someone experiencing schizophrenia, bachelor’s degree or above, females and an understanding of the recovery-oriented practice26.

What is recovery-oriented practice, and how does this help schizophrenia suffers? 

Recovery-oriented practice encourages the application of sets of capabilities to support people to recognise and take responsibility for their recovery, wellbeing, goals and aspirations27. Central to the approach is a collaborative understanding of the individual’s personal recovery goals, rather than a focus on symptom reduction28. However, factors such as the type of client-clinician involvement, tertiary training, etiologic perspective and general attitudes towards persons with schizophrenia, have been found to influence practitioners understanding of recovery29.

Disclaimer: For all allied health professionals, always follow the appropriate processes and procedures of your organisation when meeting with your clients.

References

  1. Morgan, V. A., Waterreus, A., Jablensky, A., Mackinnon, A., Mcgrath, J. J., Carr, V., … Saw, S. (2011). Report on the second Australian national survey People living with psychotic illness 2010. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/717137a2f9b9fcc2ca257bf0001c118f/$file/psych10.pdf
  2. Janssen, I., Krabbendam, L., Bak, M., Hanssen, M., Vollebergh, W., de Graaf, R., & van Os, J. (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica, 109(1), 38–45. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14674957
  3. Janssen, I., Krabbendam, L., Bak, M., Hanssen, M., Vollebergh, W., de Graaf, R., & van Os, J. (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica, 109(1), 38–45. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14674957
  4. Morgan, V. A., Waterreus, A., Jablensky, A., Mackinnon, A., McGrath, J. J., Carr, V., … Saw, S. (2012). People living with psychotic illness in 2010: The second Australian national survey of schizophrenia. Australian & New Zealand Journal of Psychiatry, 46(8), 735–752. https://doi.org/10.1177/0004867412449877
  5. Morgan, V. A., Waterreus, A., Jablensky, A., Mackinnon, A., McGrath, J. J., Carr, V., … Saw, S. (2012). People living with psychotic illness in 2010: The second Australian national survey of schizophrenia. Australian & New Zealand Journal of Psychiatry, 46(8), 735–752. https://doi.org/10.1177/0004867412449877
  6. De Hert, M., Correll, C. U., Bobes, J., Cetkovich-Bakmas, M., Cohen, D. A. N., Asai, I., … Leucht, S. (2011, February). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. https://doi.org/10.1002/j.2051-5545.2011.tb00014.x
  7. Magliano, L., Rinaldi, A., Costanzo, R., De Leo, R., Schioppa, G., Petrillo, M., & Read, J. (2016). Improving psychology students’ attitudes toward people with schizophrenia: A quasi-randomized controlled study. The American Journal of Orthopsychiatry, 86(3), 253–64. https://doi.org/10.1037/ort0000161
  8. Cooke, A. (2014). Understanding Schizophrenia and Schizophrenia. The British Psychological Society, 94–99. https://doi.org/https://doi.org/10.1176/appi.pn.2017.5a13
  9. Angermeyer, M. C., & Dietrich, S. (2006). Public beliefs about and attitudes towards people with mental illness: A review of population studies. Acta Psychiatrica Scandinavica, 113(3), 163–179. https://doi.org/10.1111/j.1600-0447.2005.00699.x
  10. Coverdale, J., Nairn, R., & Claasen, D. (2002). Depictions of mental illness in print media: A prospective national sample. Australian and New Zealand Journal of Psychiatry, 36(5), 697–700. https://doi.org/10.1046/j.1440-1614.2002.00998.x
  11. Lauber, C., Nordt, C., Falcato, L., & Rossler, W. (2000). Public acceptance of restrictions on mentally ill people. Acta Psychiatrica Scandinavica, 102(s407), 26–32. https://doi.org/10.1034/j.1600-0447.2000.00005.x
  12. Corrigan, P. W., Edwards, A. B., Green, A., Diwan, S. L., & Penn, D. L. (2001). Prejudice, Social Distance, and Familiarity with Mental Illness. Schizophrenia Bulletin, 27(2), 219–225. https://doi.org/10.1093/oxfordjournals.schbul.a006868
  13. Corrigan, P. W., Edwards, A. B., Green, A., Diwan, S. L., & Penn, D. L. (2001). Prejudice, Social Distance, and Familiarity with Mental Illness. Schizophrenia Bulletin, 27(2), 219–225. https://doi.org/10.1093/oxfordjournals.schbul.a006868
  14. Angermeyer, M. C., Holzinger, A., & Matschinger, H. (2009). Mental health literacy and attitude towards people with mental illness: A trend analysis based on population surveys in the eastern part of Germany. European Psychiatry, 24(4), 225–232. https://doi.org/10.1016/j.eurpsy.2008.06.010
  15. Corrigan, P. W., Edwards, A. B., Green, A., Diwan, S. L., & Penn, D. L. (2001). Prejudice, Social Distance, and Familiarity with Mental Illness. Schizophrenia Bulletin, 27(2), 219–225. https://doi.org/10.1093/oxfordjournals.schbul.a006868
  16. Pavon, G., & Vaes, J. (2017). Bio-genetic vs. psycho-environmental conceptions of schizophrenia and their role in perceiving patients in human terms. Schizophrenia, 9(3), 245–253. https://doi.org/10.1080/17522439.2017.1311359
  17. Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., & Pescosolido, B. A. (1999). Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. American Journal of Public Health, 89(9), 1328–1333. https://doi.org/10.2105/AJPH.89.9.1328
  18. Angermeyer, M. C., Holzinger, A., Carta, M. G., & Schomerus, G. (2011). Biogenetic explanations and public acceptance of mental illness: Systematic review of population studies. British Journal of Psychiatry. https://doi.org/10.1192/bjp.bp.110.085563
  19. Read, J., Van Os, J., Morrison, A. P., & Ross, C. A. (2005). Childhood trauma, schizophrenia and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/j.1600-0447.2005.00634.x
  20. Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., & Henderson, S. (1999). Attitudes towards people with a mental disorder: A survey of the Australian public and health professionals. Australian and New Zealand Journal of Psychiatry, 33(1), 77–83. https://doi.org/10.1046/j.1440-1614.1999.00513.x
  21. Kvaale, E. P., Haslam, N., & Gottdiener, W. H. (2013). The “side effects” of medicalization: A meta-analytic review of how biogenetic explanations affect stigma. Clinical Psychology Review. https://doi.org/10.1016/j.cpr.2013.06.002
  22. Engel, G. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460
  23. Babalola, E., Noel, P., & White, R. (2017). The biopsychosocial approach and global mental health: Synergies and opportunities. Indian Journal of Social Psychiatry, 33(4), 291. https://doi.org/10.4103/ijsp.ijsp_13_17
  24. Ghaemi, S. N. (2011). The Biopsychosocial Model in Psychiatry: A Critique. Existenz, 6(1). Retrieved from http://www.existenz.us
  25. Magliano, L., Rinaldi, A., Costanzo, R., De Leo, R., Schioppa, G., Petrillo, M., & Read, J. (2016). Improving psychology students’ attitudes toward people with schizophrenia: A quasi-randomized controlled study. The American Journal of Orthopsychiatry, 86(3), 253–64. https://doi.org/10.1037/ort0000161
  26. Couture, S. M., & Penn, D. L. (2003). Interpersonal contact and the stigma of mental illness: A review of the literature. Journal of Mental Health. https://doi.org/10.1080/09638231000118276
  27. Australian Government: Department of Health. (2013). A National framework for recovery-oriented mental health services: guide for practitioners and providers, 96. https://doi.org/10.5498/wjp.v5.i2.160
  28. Hancock, N., Scanlan, J. N., Bundy, A., & Honey, A. (2016). Recovery Assessment Scale – Domains & Stages (RAS-DS) Manual- Version 2. Sydney; University of Sydney. Retrieved from https://ses.library.usyd.edu.au/bitstream/2123/15257/2/RAS-DS_MANUAL_V2_2016.pdf
  29. Bedregal, L. E., O’Connell, M., & Davidson, L. (2006). The Recovery Knowledge Inventory: Assessment of Mental Health Staff Knowledge and Attitudes about Recovery. Psychiatric Rehabilitation Journal, 30(2), 96–103. https://doi.org/10.2975/30.2006.96.103