Schizophrenia treatment approaches, challenges and the importance of early intervention

An interview with clinical psychologist Kim Mueser about new approaches to schizophrenia treatment. 

Schizophrenia is often viewed as the most serious and debilitating mental illness. For example, rates of schizophrenia among homeless people and prisoners are high.

But – decades of research offer hope for those affected by the illness, and new approaches to treating the disorder make it possible for people to live full lives. Kim T. Mueser, a clinical psychologist and Executive Director of the Center for Psychiatric Rehabilitation at Boston University, discussed some of these new approaches with the Pulse’s Maiken Scott.

What are some of the new approaches to dealing with and treating schizophrenia?

Over the past 30 plus years, there’s been a great movement towards community-based services, and many of those services involve providing people with the practical assistance and training, and skills and coping strategies, to live rewarding lives on their own. Before this, many people spent much of their lives in psychiatric hospitals. Now, for example, there’s an emphasis on helping people live as independently as possible in the community, helping people seek and obtain jobs through programs such as supported employment, that focus on helping people get competitive jobs in integrated community settings. Probably the greatest shift in the field has been towards looking at the lives that people are capable of living and the concept of recovery. People living worthwhile and rewarding lives despite the fact that they may experience symptoms.

What are the major barriers that remain? We hear a lot about homeless people, people in prisons, and the rates of schizophrenia among those people are high.

You’re absolutely right. One barrier, certainly, that remains is despite the fact that the field of psychiatric rehabilitation and pharmacological treatments and other areas have made tremendous strides in recent decades, most effective services are not available to people in their community settings.

What do we know about outcomes for people who are living with schizophrenia? It’s often viewed as the most devastating mental illness.

It’s true that many people may continue to have symptoms throughout much of their lives. However we do also know that significant numbers of people do recover from schizophrenia, both symptomatically and functionally. We also know that not everybody who experiences a psychotic episode goes on to experience a long term course of schizophrenia.

What’s the importance of early intervention?

One of the most important things about early intervention has to do with the fact that the longer one waits to intervene after a person has developed psychotic symptoms, the more severe the symptoms tend to get, the more impaired the functioning becomes, and the more difficult it is to help the person get on with their lives. Often when people have not been able to access effective treatment during the early stages of the illness, they may withdraw, family members may withdraw out of frustration, and what happens is that ineffective coping strategies get put in place. Sometimes people end up turning to substance use and problems such as that which make it all the more difficult to help stabilize the person’s symptoms and to get them moving forward in their life paths again.

Do we as a society understand schizophrenia better than we used to?

I believe we do understand it better. I believe that there have been a lot of efforts to correct public misconceptions. There’s certainly been a movement to have people who have experienced the disorder speak publicly about their experiences. For example the experiences of the Nobel Prize winner John Nash in the movie “A Beautiful Mind” really brought home, I believe, a lot of accurate information to the American public about the nature of schizophrenia. That this is not a disorder in terms of a split personality, that people are not violent, and that the psychotic symptoms that people often experience are as real to the person experiencing them as reality is to you and I, in our experience of it.