Barriers to the Treatment of Schizophrenia and Other Serious Mental Illnesses

In 2005, a mental health study was mandated to examine the extent of the problem of discontinuation of therapy and treatment for patients experiencing mental illnesses, including schizophrenia, bipolar disorder and depression. The study examined the factors that influenced whether these patients followed through with the full course of prescribed medications or not. As part of the study, 76 in-depth qualitative interviews were conducted with a panel of inpatient hospital psychiatrists and discharge planners and outpatient (community mental health center) psychiatrists and intake coordinators from across four states. The respondents stated that, on average, 50 percent of consumers discharged from inpatient facilities do not appear for their initial take appointment at the outpatient / community-based program to which they were referred.

Several factors were identified on the system, program / provider, and individual levels that were related to such a poor rate of continuity of therapy for approximately half of the study participants.

System Level Health Care Barriers:

– The system is fragmented and fractured.
– The basics of the discharge and take processes are similar across states; however, the flow of communication varies significantly by state and consumer profile.
– Certain prescribed psychotropic medications do not appear on hospital formularies, thus creating transition issues for consumers both within inpatient settings and post-discharge.
– Financing and cost considerations.

Facility / Program Level Health Care Barriers:

– The role of inpatient short-stay hospitals is clearly defined as triage, stabilization and, discharge.
– Most outpatient facilities see their responsibility for the continuum of care beginning only when the consumer actually shows up for take.
– Either setting (inpatient or outpatient) is appropriately set up to ensure continuity of care.
– Communication breakdown between settings.
– Psychiatrists from both inpatient and outpatient settings report that they very rarely interact with mental illness patients in the other setting.
– Most communication between inpatient and outpatient facilities takes place between the inpatient discharge planner (typically a social worker) and the outpatient intake coordinator (typically a case manager).
– These correspondents, the primary conduits of information flow between settings, characterize their work environment as "overburdened" and "overworked."
– Unless specifically mandated or required, processes relating to discharge or receipt are unlawfully to be put in place, let alone followed consistently; when policies exist, they tend to be idiosyncratic to the particular facility.

Provider and Individual Level Health Care Barriers:

– It was very clear that many consumers, upon discharge, were not completely stabilized and had little specific awareness of their medications beyond the name (s).
– Issues faced by consumers including: stigma, side effects from medicines, co-occurring disorders, homelessness, lack of transport, and lack of support systems.
– Consumers acknowledged they were provided information about their medications at discharge, but report the information was given in very general terms (eg "this will make you feel stable") and there was little recall regarding details.

Obviously, steps must be taken to improve the continuity of care for mental health patients. This can only be achieved by addressing and removing these barriers on all levels. Mental health professionals agree that removing these barriers is a reality that can, and should, be realized today.