The persistent and debilitating symptoms of schizophrenia not only impact the lives of patients; they also affect caregivers and communities. The need for caregiving support increases with the increasing severity of schizophrenia symptoms.1 Caregiver support can vary from emotional and financial support to helping complete daily tasks and promoting medication adherence.2 Thus, caregivers play an essential role in supporting patients with schizophrenia.
The Role of a Caregiver
Treating schizophrenia frequently involves monitoring, which may be difficult for patients with schizophrenia to manage on their own. For instance, the required bloodwork associated with clozapine therapy necessitates managing regular clinic visits to maintain access to the medication.3 Symptoms of schizophrenia can interfere with the ability to complete daily activities; therefore, caregivers can play an essential role in ensuring that these clinical visits are not missed.
It can be equally challenging for patients with schizophrenia to manage the adverse events associated with their treatments, including motor side effects, sedation, and weight gain, all of which may contribute to poor medication adherence if not addressed.
Community Support
Community-based interventions are known to have a positive effect on the management of symptoms in patients with schizophrenia.4 For example, case managers coordinate health and social care services to create individualized care plans for patients. Less insightful patients who require more focused care can benefit from this coordinated and intensive case management.5
Patients who are frequently hospitalized and who require additional care at home or work can benefit from assertive community treatment. This community approach utilizes a holistic model of care and has been adapted to assist patients with other psychotic disorders, with the goal of preventing the need for rehospitalization.
Lastly, a crisis intervention program is critical during an acute psychiatric crisis. The crisis intervention team can provide practical guidance, support for family members, and assistance with treatment.5
Another option available in some urban areas is the clubhouse model, which focuses on empowering patients with schizophrenia through the development of a community within a safe environment. This feeling of community is further reinforced by supportive relationships and clubhouse-related employment activities to help foster ownership and responsibility.5
Housing Models
Patients with schizophrenia are at risk for homelessness.5 Similar to community-based support, several models have been proposed to address patient housing needs.
Housing First is a noncoercive, evidence-based model effective in patients at high risk of homelessness, such as patients with schizophrenia.5
The Home Again model may be an option for clinically stable patients who want to retain autonomy in selecting their own housing. In this model, multiple clinically similar patients with a moderate level of disability live together in a home and either have an onsite social worker or a social worker who regularly visits the home. Patients are encouraged to maintain more independence by managing daily self-care tasks, such as cooking and housekeeping.5
Conclusion
The management of schizophrenia encompasses not only the direct treatment of the condition but also the vital support provided by caregivers and community resources. Caregivers are essential in ensuring medication adherence and managing treatment-related challenges, while community-based interventions enhance symptom management through coordinated care and crisis support. Housing models address the risk of homelessness and promote stability for patients. These collaborative approaches empower individuals with schizophrenia, fostering independence and improving their overall quality of life. Ultimately, a multifaceted support system is crucial for addressing the complex needs of patients and their caregivers.
For more information, please see the other blogs in this series:
References:
- Brain C, Kymes S, DiBenedetti DB, Brevig T, Velligan DI. Experiences, attitudes, and perceptions of caregivers of individuals with treatment-resistant schizophrenia: a qualitative study. BMC Psychiatry. 2018;18(1):253. doi:10.1186/s12888-018-1833-5
- Yıldız M, Demir Y, Kırcalı A, İncedere A. Caregiver burden in schizophrenia and autism spectrum disorders: a comparative study. Psychiatry Investig. 2021;18(12):1180-1187. doi:10.30773/pi.2021.0165
- Hany M, Rehman B, Rizvi A, Chapman J. Schizophrenia. In: StatPearls. StatPearls Publishing; 2024.
- Asher L, Patel V, De Silva MJ. Community-based psychosocial interventions for people with schizophrenia in low and middle-income countries: systematic review and meta-analysis. BMC Psychiatry. 2017;17(1):355. doi:10.1186/s12888-017-1516-7
- Gowda GS, Isaac MK. Models of care of schizophrenia in the community-an international perspective. Curr Psychiatry Rep. 2022;24(3):195-202. doi:10.1007/s11920-022-01329-0