2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

Schizophrenia Management as Part of Home Health Care

The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting human beings. Schizophrenia is comprised of several symptoms.  Symptoms of this illness can also be found in other mental illnesses.  However, when “the symptoms of schizophrenia have been present for a significant portion of time during a one month period (or shorter if successfully treated), with some signs of the disorder persisting for at least six months and is not better accounted for by Schizoaffective Disorder or a Mood Disorder with psychotic features, and the symptoms are not due to a physiological effect of a substance or general medical condition”, then a diagnosis of Schizophrenia can be made ( DSM-IV-TR, 2000 pg. 298-299).

The symptoms of schizophrenia typically are divided into three categories positive, negative, and cognitive symptoms. Positive symptoms, or psychotic symptoms, include delusions, catatonic behavior and hallucinations. Positive symptoms refers to having symptoms that should not be there. Negative symptoms include affective flattening or lack of expression, avolition or an inability to initiate and follow through with activities, alogia or speech that is brief and devoid of content. Negative symptoms refers to a lack of certain characteristics. Cognitive symptoms refers to thinking processes. This is frequently exhibited in lack of organization in their thoughts and in lack of insight. (DSM-IV-TR, 2000 pg 297-302; National Alliance on Mental Illness www.nami.org, schizophrenia fact sheet)

Although incurable, schizophrenia is treated and managed with medications and a variety of therapeutic approaches. The primary medications for schizophrenia are called antipsychotics. Antipsychotics help relieve the positive symptoms of schizophrenia. Newer antipsychotics reduce the positive symptoms such as hallucinations and delusions, but also relieve the negative symptoms of the illness, e.g., withdrawal, disorganized thoughts, and lack of insight.

People with schizophrenia often benefit from continuing day treatment programs. Substance abuse counseling, vocational skill development, employment and appropriate housing are essential to helping the individual with schizophrenia assimilate into the community and function at their optimal level. Peer mentoring and support groups are also helpful for people with schizophrenia and their families.

Recovery and remission in schizophrenia is receiving increased attention. Many researchers are looking at recovery not from a consumer perspective but from a clinical perspective. Researchers are trying to quantify recovery and remission in schizophrenia utilizing scales which measure symptoms and functional ability. Measuring the severity of both positive and negative symptoms and functional ability is thought to be key in establishing criteria for clinical remission.

Building a life in the community is part of the recovery process. A goal of all treatment is for individuals to be active members of the community. In order for this to be accomplished it is important to identify a person’s strengths, capacities, preferences and needs, as well as, their knowledge of their local community, its opportunities, resources and potential barriers. This will enable the individual to find their niche in the community in which they reside.

Patient independence and the ability for the patient to recover at home are among the primary objectives at Visiting Nurse Services in Westchester. VNSW’s services allow individuals with all levels of mental illness the ability to remain in their homes and involved in the community mental health programs that are an integral part of their treatment. The agency’s ability to monitor psychiatric symptoms and medication compliance – in addition to teaching the skills needed by each individual to help manage their specific psychiatric needs- empowers patients to obtain their optimal level of independent functioning/living. VNSW’s nurses regularly observe individuals in their homes, enabling the agency to provide feedback to caseworkers on the appropriateness of the patients housing and often to assist in obtaining housing with increased or decreased supportive services. VNSW nurses have the ability to help the patient advocate for their desired needs as they see the person in their environment and are well aware of their needs and ability to remain safely in their homes. The nurse can often intervene with symptom management before problems reach a level requiring hospitalization, thus enabling patients to remain at optimum level of function, with minimal interruption.

At Visiting Nurse Services in Westchester, patients are considered partners – the agency works together with patients toward recovery and reaching a maximum level of independent functioning. The staff supports and encourages patient independence and its services strengthen care coordination. VNSW’s mental health program is an important adjunct service to community mental health services. The program provides daily visits 365 days per year, if needed. VNSW works collaboratively with the patient, supportive and intensive case managers, and the agency’s flexible visitation schedule is designed to accommodate patients’ day treatment attendance. VNSW’s nurses offer their patients support and monitoring to ensure success by offering an individually tailored care plan to meet each persons needs as they arise, before they reach crisis levels.

In addition to nursing care, VNSW provides a full range of rehabilitative therapies, social work and home health aide services; psychiatric patients receive comprehensive care from a coordinated team of health care professionals versed in, and sensitive to, their complete history and needs, providing a complete package of essential multidisciplinary services to help them, following a hospital discharge, to attain and maintain optimal health and functioning in their communities.

With its dedicated Mental Health Home Care Program, Visiting Nurse Services in Westchester is achieving this objective, emphasizing treatment of the whole person with the agency’s core multidisciplinary approach. For details, visit www.vns.org, call (914) 682-1480 Ext. 648 or e-mail MentalHealth@vns.org.

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