Today marks National Schizophrenia Awareness Day, a day that exists to shine a light on those living with the condition. Schizophrenia is thought to affect every 1 in 100 people in the UK.
Tegan Rix, Senior Occupational Therapist at Nightingale Hospital, shares that occupational therapists have a large role in the assessment and treatment of individuals diagnosed with schizophrenia. She shares more information on the role of occupational therapy in the treatment of schizophrenia in a blog below.
How can occupational therapists help treat those with schizophrenia?
Occupational therapists (OT) are concerned about how a disease or diagnosis impacts a person’s ability to function in their day-to-day life. Specific to schizophrenia, the role of occupational therapy is ultimately focused on occupational engagement and occupational balance.
Occupational engagement is viewed as a lifestyle characteristic which involves occupational performance and the interplay among personal, occupational and environmental factors. Occupational engagement can further be described as the extent to which a person has a balanced rhythm of activity and rest, a variety and range of meaningful occupations and routines, and the ability to move around in society and interact socially over a lifetime. This cyclical experience is what maintains a sense of identity of the self and well-being (Bejerholm2007). Ultimately, this is what OT works to assess and re-establish in treatment.
Disorganised thinking as a result of schizophrenia can result in grossly disorganised behaviour and the deterioration of activities of daily living (ADL). Changes in a person’s cognitive functioning can impact a person’s ability to function and perform competently and to their satisfaction. Perception, motor activity and changes in a person’s effect commonly occur which is a primary focus of OT intervention.
The way in which OTs achieve occupational engagement and balance is through purposeful activity specifically selected to achieve treatment goals. Psychosocial OT is concerned with helping persons with schizophrenia become occupied with experiences that are real. Purposeful activity through occupational engagement is central.
Occupational therapists may use activities as means to achieve a treatment goal, or activity can be used as an end – if the goal is to be able to engage in a task or activity with a certain degree of independence. Depending on the individual’s setting and the needs for treatment, occupational therapists may use a certain model for intervention. Commonly used include the model of human occupation (MOHO) which can be used to focus on motivation to participate in ADL, as an example. Alternatively, the behaviour modify intervention (BMI) can be used in behaviour therapy to change habits which are currently dysfunctional.
Occupational therapy treatment settings for schizophrenia
Both the NHS and NICE have produced insightful guidelines on how people who have schizophrenia should be cared for which include the OT skill set. OT can work in acute/short-term hospital-based inpatient units, in mid-to-long-term hospital settings, outpatient settings or in the community.
OTs also assess and treats individuals with this diagnosis on an individual and group therapy level. Depending on the setting, aims of assessment and treatment differ. Ultimately, OT has an emphasis on focusing on an individual’s remaining capacity, and not on the residual symptoms. This allows OT to emphasis the persons individuality, responsibility and sense of self- reliance rather than on illness of dependency.
Acute/short-term hospital-based units
During this stage, OT would focus on assessment and evaluating a person’s strengths, weaknesses, skills and impairments. Assessment will include observation and activity analysis of daily life occupations. Limited rehabilitation takes place during this time. One of the main aims in this setting after assessment is sharing community-based resources and working on a discharge plan as part of the hospital-based stay. Individuals who are not referred at this time lose quality of life in the community.
Midterm and long-term hospital settings
From research findings, we know that the OT role is useful for providing an introduction to daily occupations which include self-variables so that they can start to interpret, experience and relate to the world around them. Engagement that facilitates self-definition and corresponds to a person’s internal need is the focus. OT programmes in this setting would normally involve elements of practicality, problem-solving of every day challenges, socialisation, planned recreation, engaging in attainable tasks and goal- orientation.
Community rehab allows for a multidisciplinary treatment team (MDT) to support the individual in their community with regards to their ability to function in their social, vocational, educational and familial roles. Community based programmes can be hard to find.
Alternatively, private OT’s can provide psycho-social support in the community. For a person with this schizophrenia, it is essential for them to be seen, function and exist in a community without being shunned or appearing bizarre. This is not an easy goal due to the stigma and misinterpretation of this diagnosis. Popular movies that have been seen by many is has developed a skewed understanding of this diagnosis and how people may treat others in the community.
OT may support persons in the community, with an MDT with regard to: training in social and independent living skills, family psycho-education, medication adherence and management, awareness of symptoms and supported housing and employment. Continuous rather than radical and short-term treatments is imperative and for this reason rehabilitation needs to be consistent and long-term.
Individual and group therapy
It is advised that during the initial stages, after assessment, that a person with Schizophrenia should be treated individually or if in a group setting, should be given their own activity to engage in.
Groups are a common mode of therapy within a hospital-based setting. Groups can be focused on personal care and self- independence, creative activities as means of leisure pursuit, sensory integration groups if relevant, exercise or movement-based groups, social skills training to counteract pervasive deficits in social functioning’s and coping skills training.
Other treatment focuses
Other treatment focuses may include vocational assessment and rehabilitation, and discharge planning for continued care.
Psycho-education is an essential part of treatment and studies have shown pleasing results in the effectiveness of managing the diagnosis. Sessions can be run on an individual or group basis and we would encourage to include patients and their caregivers. Group contents includes promoting insight into the diagnosis, medication compliance and understanding the role of medication, relapse prevention, psycho-social treatment strategies, family support and sharing with caregivers the role the can play in supporting an individual.