Schizophrenia is usually treated with an individually tailored combination of talking therapy and medicine.
Most people with schizophrenia are treated by community mental health teams (CMHTs).
The goal of the CMHT is to provide day-to-day support and treatment while ensuring you have as much independence as possible.
A CMHT can be made up of and provide access to:
- social workers
- community mental health nurses – who have specialist training in mental health conditions
- occupational therapists
- pharmacists
- counsellors and psychotherapists
- psychologists and psychiatrists – the psychiatrist is usually the senior clinician in the team
During your first episode of schizophrenia, you should initially be referred to an early intervention team.
These specialist teams provide treatment and support, and are usually made up of psychiatrists, psychologists, mental health nurses, social workers and support workers.
Depending on your needs, you may be in regular contact with just 1 or 2 members of the team or you may need help from the entire CMHT.
Care programme approach (CPA)
People with complex mental health conditions are usually entered into a treatment process known as a care programme approach (CPA). A CPA is essentially a way of ensuring you receive the right treatment for your needs.
There are 4 stages to a CPA:
- assessment – your health and social needs are assessed
- care plan – a care plan is created to meet your health and social needs
- key worker appointed – a key worker, usually a social worker or nurse, is your first point of contact with other members of the CMHT
- reviews – your treatment will be regularly reviewed and, if needed, changes to the care plan can be agreed
You'll work together with your healthcare team to develop a care plan. The care plan may involve an advance statement or crisis plan, which can be followed in an emergency.
Your care plan should include a combined healthy eating and physical activity programme and support for giving up smoking, if you smoke.
Your care co-ordinator will be responsible for making sure all members of your healthcare team, including your GP, have a copy of your care plan.
Further information
Managing acute episodes
People with schizophrenia can experience what is known as an acute schizophrenic episode. During an acute episode the symptoms of psychosis, where a person is unable to tell the difference between reality and their imagination, can become overwhelming.
During this time, a person may require a more intensive level of care than a CMHT can provide, to help keep them safe from harm.
Crisis resolution teams (CRT)
A treatment option is to contact a home treatment or crisis resolution team (CRT).
CRTs care for people with serious mental health conditions who are currently experiencing an acute and severe psychiatric episode, sometimes called a 'crisis'.
The aim of a CRT is to support people without having to admit them to a hospital (but they can arrange admission if needed).
The CRT aims to treat people in the least restrictive environment possible, ideally in or near their home. This can be in your own home, in a dedicated crisis residential home or hostel, or in a day care centre.
CRTs are also responsible for planning aftercare once the crisis has passed to prevent a further crisis occurring.
Your care co-ordinator should be able to provide you and your friends or family with contact information in the event of a crisis.
Treatment in a hospital or clinic
People who are undergoing a very severe schizophrenia episode may require in-patient care at a hospital or psychiatric clinic.
If a person’s care team think they would be best cared for in a hospital or clinic, they will explain that to the person and encourage them to admit themselves for care.
There may be times when a person refuses to go into hospital but the clinic feels that they do not have the mental capacity to make an informed decision about their own care. Read more about how health professionals assess a person’s capacity to make a decision.
In situations like this the Mental Health Act (2007) does legally allow a person to be compulsorily detained at a hospital or clinic. It must be thought that detention is necessary to protect:
- that person’s health and safety
- the health and safety of others
Sometimes the wards need to be locked for the safety of the people being cared for.
All people being treated in hospital will stay only as long as is absolutely necessary for them to receive appropriate treatment and arrange aftercare.
An independent panel will regularly review your case and progress. Once they feel you're no longer a danger to yourself and others, you'll be discharged from hospital. However, your care team may recommend you remain in hospital voluntarily.
More serious acute schizophrenic episodes may need to be cared for in a psychiatric ward at a hospital or clinic.
If the care team think a person would be best cared for on a ward, they will talk to the person and encourage them to admit themselves voluntarily to hospital.
Rarely, if a person's care team feels they are not able to make the decision for themselves they may need to be admitted under the Mental Health Act (2007). This is sometimes called 'compulsorily admission'.
It's only possible for someone to be compulsorily admitted to a hospital if they have a severe mental health condition and it's in the best interests of:
- the person's own health and safety
- the health and safety of others
All people being treated in hospital will stay only as long as is absolutely necessary for them to receive appropriate treatment and arrange aftercare.
An independent panel will regularly review the person's progress. Once they feel the level of risk has lowered, the person can be discharged from hospital. However, the care team may recommend they stay in hospital voluntarily.
Advance statements
If it's felt there's a significant risk of future acute schizophrenic episodes occurring, you may want to write an advance statement.
An advance statement is a series of written instructions about what you would like your family or friends to do in case you experience another acute schizophrenic episode. You may also want to include contact details for your care co-ordinator.
An advanced statement can also give instructions on how you want to be cared for if you're not in a position to make decisions about treatment yourself.
These instructions can include your wishes regarding your treatment and who you would like to be contacted, such as a family member or a friend, in the event of a crisis.
Advanced statements are not legally binding, so health professionals will always act in your best interest when required, but they will follow your wishes whenever possible.
If you want to make an advance statement, talk to your care co-ordinator, psychiatrist or GP.
Further information:
Antipsychotics
Antipsychotics are usually recommended as the initial treatment for the symptoms of an acute schizophrenic episode. They work by blocking the effect of the chemical dopamine, or other chemicals on the brain.
Antipsychotics can usually reduce feelings of anxiety or aggression within a few hours of use, but may take several days or weeks to reduce other symptoms, such as hallucinations or delusional thoughts.
Your doctor may recommend a physical examination, and possibly some scans, such as an ECG. It's important that your doctor gives you a thorough physical examination before you start taking antipsychotics, and that you work together to find the right one for you.
Antipsychotics can be taken orally as a pill, or be given as an injection known as a depot. Several slow-release antipsychotics are available. These require you to have one injection every 1 to 4 weeks. You will usually be given the lowest dose possible that it thought able to effectively control symptoms.
You may only need antipsychotics until your acute schizophrenic episode has passed.
However, most people take medication for 1 or 2 years after their first psychotic episode to prevent further acute schizophrenic episodes occurring, and for longer if the illness is recurrent.
There are 2 main types of antipsychotics:
- typical antipsychotics – the first generation of antipsychotics developed in the 1950s
- atypical antipsychotics – newer-generation antipsychotics developed in the 1990s
The choice of antipsychotic should be made following a discussion between you and your psychiatrist about the likely benefits and side effects.
Both typical and atypical antipsychotics can cause side effects, although not everyone will experience them and the severity will differ from person to person.
The side effects of typical antipsychotics include:
- shaking
- trembling
- muscle twitches
- muscle spasms
Side effects of both typical and atypical antipsychotics include:
- drowsiness
- weight gain, particularly with some atypical antipsychotics
- lack of sex drive
- blurred vision
- constipation
- dry mouth
Antipsychotics can also cause side effects which may need to be monitored while you are taking them. These include:
- an increase in your blood cholesterol levels
- changes in your blood sugar levels
- your blood pressure can become both higher or lower than usual
Tell your care co-ordinator, psychiatrist or GP if your side effects become severe. There may be an alternative antipsychotic you can take or additional medicines that will help you deal with the side effects.
If you do not benefit from your antipsychotic medicine after taking it regularly for several weeks, an alternative can be tried. It's important to work with your treatment team to find the right medicine for you.
Do not stop taking your antipsychotics without first consulting your care co-ordinator, psychiatrist or GP. If you stop taking them, you could have a relapse of symptoms.
Your medicine and any side effects will be closely monitored for the first few months. After this your medicine should be reviewed at least once a year.
Further information
Talking therapies
Talking therapies can help people with schizophrenia cope with the symptoms of hallucinations or delusions better.
They can also help treat some of the negative symptoms of schizophrenia, such as apathy or a lack of enjoyment and interest in things you used to enjoy.
Talking therapies for schizophrenia work best when they're combined with antipsychotic medication.
Common talking therapies for schizophrenia include:
- cognitive behavioural therapy (CBT)
- family therapy
- arts therapy
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) aims to help you identify the thinking patterns that are causing you to have unwanted feelings and behaviour, and learn to change this thinking with more realistic and useful thoughts.
For example, you may be taught to recognise examples of delusional thinking. You may then receive help and advice about how to avoid acting on these thoughts.
Most people require a series of CBT sessions over the course of a number of months. CBT sessions usually last for about an hour.
Your GP or care co-ordinator should be able to arrange a referral to a CBT therapist.
Family therapy
Family therapy aims to support the person with schizophrenia and the people they live with or are close to, such as partners or family members.
It can help everybody that may be affected by schizophrenia, not just the individual living with the condition.
It usually involves informal sessions over the course of 6 months.
Family therapy sessions may include:
- discussing information about schizophrenia
- exploring ways of supporting somebody with schizophrenia
- deciding how to solve practical problems that can be caused by the symptoms of schizophrenia
- planning what to do in a crisis situation
If you think you and your family could benefit from family therapy, speak to your care co-ordinator or GP.
Arts therapy
Arts therapies are designed to promote creative expression. Working with an arts therapist in a small group or individually can allow you to express your experiences with schizophrenia.
Some people find expressing things in a non-verbal way through the arts can provide a new experience of schizophrenia and help them develop new ways of relating to others.
Arts therapies have been shown to alleviate the negative symptoms of schizophrenia in some people.
The National Institute for Health and Care Excellence (NICE) recommends that arts therapies are provided by an arts therapist registered with the Health and Care Professions Council who has experience of working with people with schizophrenia.