Care for people with schizophrenia still not improving, report says

There is still a significant shortfall in the quality of some aspects of care affecting the lives of people living with schizophrenia and their carers, according to the second National Audit of Schizophrenia.

Two years ago, the first report from the National Audit of Schizophrenia highlighted areas of concern, particularly the management and coordination of physical healthcare, some aspects of prescribing practice and availability of talking therapies. The second audit has re-examined these areas and looked in more depth at service users’ perception of their care.

This second National Audit of Schizophrenia found that:

• Although most service users were fairly satisfied with their quality of care, carers had some significant areas of dissatisfaction with aspects of the information and support they received

• Monitoring and intervention for serious physical health problems continues to be below acceptable standards

• The availability of talking therapies remains inadequate for those who want them. Less than 40% had been offered cognitive behavioural therapy and family intervention despite most people wanting psychological treatment to help them cope with their problems

• Some people with a diagnosis of schizophrenia are also being prescribed medication in excess of recommended doses and over half of those whose illness has not responded well to standard medications have had to wait too long to receive clozapine, a medication with greater effect for many such individuals.

The National Audit of Schizophrenia was commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme, carried out by the Royal College of Psychiatrists’ Centre for Quality Improvement (CCQI) in partnership with other organisations. It assessed the care for people affected by schizophrenia who are living in the community in England and Wales and examined how well guidelines produced by the National Institute for Health and Care Excellence were being followed.

Professor Mike Crawford, director of the CCQI and lead of the National Audit of Schizophrenia Project Team said: “The results of the second round of this audit show that many people with schizophrenia are still not getting the high quality psychological and medical treatment they deserve, and highlights the areas where the biggest improvements are needed.”

Dr David Shiers, primary care advisor to the National Audit of Schizophrenia Project Team, added: “This second audit shows a continuing failure to identify and treat those risk factors that can cause future diabetes, stroke and heart attacks. Agreement between local GPs and psychiatrists on how clinical accountability for managing physical health is allocated and how they communicate over essential clinical information is overdue.”

Professor Stephen Cooper, clinical lead to the National Audit of Schizophrenia, said: “The correct prescribing of medicines for those with schizophrenia is a vital part of their care. There is still work required within the relevant professions and within Trusts to improve this.”