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Schizophrenia report demands better care

Significant improvements in care are needed if the lives of schizophrenia sufferers are to get better, according to the first national audit for people with the severe mental illness.

The audit highlighted several areas of concern, including the management of physical health problems, prescribing practice and consultation with service users.

It found that 16% of patients in the national sample were being prescribed more than one anti-psychotic drug at the same time, and in some trusts and health boards this was 30%.

The practice is not recommended except in exceptional circumstances, with some users prescribed higher doses of medication than is recommended without clear documentation of the reasons.

Professor Stephen Cooper, clinical lead to the National Audit of Schizophrenia, said: “The correct prescribing of medicines for those with schizophrenia is a key part of their treatment.

“This audit shows good practice for the majority of affected individuals but there remain some areas of concern, particularly in relation to situations where more than one medicine is being prescribed.”

The audit also found that the majority of patients are involved in discussions about their care, but, particularly in relation to issues about medication, felt this was not always in a way that was fully understandable to them.

In addition, only 29% of service users received an adequate assessment of risk factors for cardio-metabolic disease and 43% were not even weighed within the previous 12 months.

This matters because people with schizophrenia have a considerably reduced life expectancy and the main cause of premature mortality is coronary heart disease, a disorder for which the risks are largely determined by these cardio-metabolic factors.

Key recommendations in the report include that mental health trusts should involve local people who use services, and carers, in developing local action plans for improving the care and support offered.

The report also says that psychiatrists should be aware of the upper dose limits for prescribing anti-psychotic medication and that all health professionals working with people affected by mental illness should have training on common physical health problems experienced by this group.

The National Audit of Schizophrenia was commissioned by the Healthcare Quality Improvement Partnership and carried out by the Royal College of Psychiatrists’ Centre for Quality Improvement (CCQI) in partnership with other organisations.

Professor Mike Crawford, director of the CCQI and lead of the National Audit of Schizophrenia Project Team, said: “Financial pressures on mental health services are making it harder to deliver high-quality care.

“The results of this audit show that some services are coping better with these pressures than others.

“There needs to be better co-ordination of care between GPs and mental health services if standards of care are to be improved.”

The audit 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 Clinical Excellence were being followed.


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