The impact of schizophrenia is not just limited to the ill person alone but also extend to the family member, friends and community at large. Being the main carer of a person with schizophrenia can have a toll on employment, a personal income, social life as well as psychological well-being. However, children who have people with schizophrenia may have a higher risk of experiencing stigma, discrimination, poverty, stress and the burden of becoming carers. The eligibility criteria and other characteristics that an individual must fulfill in order to gain access to specific treatment delays because of policy or legal framework. The current policy in terms of treatment and demographic transitional have a direct influence on whether a schizophrenia person receives care in the community instead of in an inpatient hospital. Nevertheless, the resilience of patients with schizophrenia and their families and new treatment approaches provides hope for the future.
This report will highlight the definition of schizophrenia and services available to them today and how frequent changes in legislature and policy, treatment and paradigm changes in demographics have had influenced the transition of children and young people to adults. It will also examine how likely it is that a person with severe mentally ill such as schizophrenia will end up living in the community with their families or living independently rather than inpatient hospital. It will further justify how factors such as social-economic, environmental, psychological, biological and risk factors these individuals face also contribute to the burden of the schizophrenia mentally ill family. The impact of using services such as social exclusion, discrimination and stigma notably if they are ethnic minorities. Finally, the report will use theories such as social drift and causation to evaluate the impact of schizophrenia in the family.
According to Hatfield (1990), schizophrenia is an intricate and debilitating disorder that can affect an individual’s life in terms of thinking, feeling and behavior with symptoms of disturbing perceptions including delusion and hallucination. The disorder tends to be chronic and episodic, and few patients with the disease return to their pre-morbid state. Recent study shows that life expectancy among people with schizophrenia is 15-20 years shorter than those without the episode Schizophrenia Commission 2012). In the aspect of service treatment for schizophrenia ill-people in the UK, there are many different services that person with schizophrenia can access. This may include community mental health teams (CMHTs). They are main responsivities is to provide treatment, assessment and social care in the community to schizophrenia ill-person. A crisis service or team is another specialist mental health team that work out of normal hours where people with mental illness can get home treatment as well as admitting people if is necessary. Train peer support is another team that is available through CMHTs to give support such motivation and encouragement to people with schizophrenia as they themselves have been through the episode and are now stable. Hospitals are the last stop where the inpatient get treatment especially those with severe mental health episodes as well as those under section. And finally, the GPs- who sometimes spot the early signs of schizophrenia and make referrers to some of the early intervention teams that might be available. However, policy regarding mental health treatment based on eligibility or means-tested sometimes prevent people from getting early diagnosis and treatment.
Socio-economic factors. How much money the person has and what occupation individuals have may affect their mental well-being. Too much wealth can be harmful – children raised in an environment where children have everything, they want may have too many, material goods but lack the security that comes from knowing they are loved for themselves and may not have the chance to develop the mental resilience needed for later life. In contrast, a child raised by a loving family who does not have much money may in fact has a greater sense of mental well-being as they learn to be creative with what they have and learn to be resilient.(Reiss, F. 2013).
Environment, endowment and experience. The immediate environment around us affects mental well-being. A child who is loved and valued at home and then goes to a school where a child is encouraged to develop will have a stronger mental capacity to draw on in times of adversity. If the work environment and the world value their talents they will draw strength from that, but if they experience unemployment and redundancy, they can draw on their mental capital and know that they are valued by their family. In contrast, a child who is abused at home verbally, physically and emotionally, may lack the confidence to cope in a school environment and has nothing to draw on as they get older and face the world beyond. A child may be endowed with the potential to do well but the environment they are in will determine if they can use their talents. (Fryers and Brugha, 2013); (Marmot Review Team, 2011) and shady et al., 2011)
Biological factors. Biological factors affect a child even before birth. A mother who is addicted to alcohol or drugs is already exposing the child to harm at these substances can cross the placental barrier. A baby born to a mother with addiction will experience withdrawal symptoms when they are born because they have been exposed to the drug during their development. In some cases, genetic inheritance is a factor in mental well-being and mental health. One study suggests that autism, ADHD, clinical depression, bipolar and schizophrenia may have common genetic risk factors; Mednick et al., 1988).
Psychological factors. Psychological factors are particularly important in the adolescent years. A young person with a sense of self-worth who is confident will be stronger and more able to resist peer pressure for harmful behaviors such as drug-taking and unprotected sex. They are more likely to grow into adults who have cognitive resilience and coping skills to deal with stresses in the relationship. As they mature into older adults, they will have greater reserves to draw on face challenges of bereavement and age-related physical and cognitive challenges (Ali et al.,2013). In contrast, children who have valued and who have not been supported to develop resilience may seek approval from others outside the home and adopt risky behaviours to gain approval from peers. Smoking, teen pregnancy, bullied, drug-taking, and gang membership is options that some young people choose in order to boost their self-esteem and a need to belong. These can then affect their life chances and their future ability to cope with stress (Ali et al.,2013).
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The socio-economic burden on Schizophrenia may impact the individuals and the filmily in many ways. Many people with schizophrenia face socio-economic and emotional stresses (Goldman 1982). This is because an individual may not be able to maintain a work relationship with others due to lack of self-motivation to get up, go to work and take part in day to day activities, this as a results leads to job lose and consequently have financial problems, consequently individual end up relying on family members to survive. Besides, the lack of employability associated with those with schizophrenia aggravates parents with children who need care find it very hard to secure employment (Tolsdorf 1976). White et al (1995) argued that this socio-economic burden compounded with the chronic relapsing nature of the condition makes it almost impossible for the majority of mothers to give consistent nurturing of their children in a good environment leading to most mothers end up losing custody of their child, and to some extent, family relationships may also break down as result schizophrenia. However, people from minorities experience double economic stressors, as they consistently have lower income and less access to resources economic as well as health services notably mental health services (Lawson 1986)
Impact of discrimination and stigma on patient and family members. In many societies, traditionally strength has been admired, and weakness discouraged. As result of this approach, many people hid health problems as result suffered unnecessarily, this is because sometimes the mother of schizophrenia child faces stigma because of prejudicial beliefs attached to schizophrenia, being diagnosis of schizophrenia is very traumatic and most people do not lives openly, happy and rewarding life. Again, the stigma of the label attached to the diagnosis ‘schizophrenic’ as a result leads to loss of status, and people become more exclusive to society and being subjected to discrimination, contributing to the schizophrenia person and family member is reluctant to seek help and when they do seek the help they may have to wait before services are available (Link and Phelan 2001).
The impact on the Effect of policy, treatment and demographic transition. The Mental Health Act 1983 which give mandatory the application of compulsory treatment is based on means-tested, either the person with schizophrenia is a risk of self-harm or others come into contact. This suggests that in some cases a person suffering from schizophrenia must fail mental capacity or reach a point of self-harm or harm somebody before the person receive medical attention (Cockerham, 1992,313). Besides, the demographic transition attached to the policy and treatment among certain groups illustrates numerous problems such as lack of continuity, different service ethos and approaches, many families must cope with changes and the way they are viewed and valued. The curtailed of treatment when children reached the age of 18 years and become adults create conflict between children social services and adults social service about who should be responsible in terms of cost.
This trend also shows that whenever there is a delay in the transition of youth schizophrenia from community to hospital due to CAMHS shortage beds increase the level of risk among children and young people undergo. These risks may include self-harm, suicide, sexual and violent assault (Lewis et al 2005 and NICE NG43 2016). Burr et al. (1979); (Caton et al. (1999) and White et al. (1995) argued that the demographic trends also shows a high level of people with schizophrenia becoming parents and women leading the chased. However, miller and Finnerty (1996); Mowbray et al. 1995a, 1995b; White et al. (1995) strongly argued that women with schizophrenia are not just likely to become parents but also most of the pregnancies are unplanned consequently causing divorce and they are more likely to raise the children by themselves.
Although the transitional of schizophrenia inpatient health setting to community, care home, shelter accommodation or back to their family as way of deinstitutionalisation by the policy has had negative impact on those people using the services and their families. The main issues arising from this deinstitutionalisation are the lack of integrated service and collaborative working practitioners. This has led to inadequate and break-up of support for service users leading to a pattern of discharge, relapse, readmission and so forth. (Goodwin 1997). Further, the delays and timing of admission in the transition of schizophrenia mental ill-patient from the community to the hospital due to shortage of inpatient beds, means that those vulnerable people cannot access services on time when they needed it most. This exacerbates the stress and depression among the patients and their families endured and to some extent leading to the unbearable burden on families (Gasby and Tew 2015).
How do social drift and social causation justify the impact of schizophrenia diagnosis? The social drift theory believed that individuals with schizophrenia drift to the bottom of society as they tend to lose their status. This means that; those in a high social class tend to lose social class and fall to the lower bottom of classes. This is because individuals with the condition end up losing touch with reality, by ignoring society as it does not make sense to them, and consequently leads to downwards spiral of poverty and loss of status. On the other hand, the social causation theory believed that individuals become schizophrenic due to being in lower classes and they’re more likely to face stressors and triggers such as living in a deprived environment. This suggests that, people with the condition are been rejected by the society, because majority of people does not engage with them and actively excludes them (Nurius et al., 2003);(Patel et al., 1999., cited in WHO 2001, p.40) and (Wilkinson, 2005). This is to justify that, both theory play a big role in terms of diagnosis with schizophrenia as people in lower classes are more likely to have been diagnosing schizophrenia due to everyday hardship whilst people in high class may be seen as ‘eccentric.’ Nurius et al., (2003) critically strongly argued that people with higher socioeconomic status are more likely to have lower risk of emotional disorders and vice versa.
The prevalence of schizophrenia as of the year 2012 estimated 0.5% and it was estimated that 220,000 people living in England with the disease. The population affected were categorise as follows: prisoners accounted 4%, 2% are reported to be in secure hospitals, 5% are under section of mental health Act in acute care units, 9% in acute care units were voluntarily admitted, 49% were report to be under some sort of secondary mental health services and 31% being under the care of the primary care team. These also have a significant impact on the victims, their families and the society at large. The cost of schizophrenia in England is estimated to be approximately 12 billion with equivalent of 60,000 per head and per year depending the region individuals’ lives and it cost public sector alone £7billion which is equivalent to£36,000 per head per annum.