15 - Psychosis

Summary

The challenges

People who develop a psychosis can find themselves strangers in their own land (Box 15.1). The health and social effects create spirals of decline and a loss of autonomy which can quickly become entrenched and difficult to address. This situation would be unacceptable in almost any other area of healthcare. It is time, therefore, to re-examine not only how primary care practitioners think about people with psychosis, but also how health services can be better organised to provide 21st-century care for patients.

What do we mean by the term ‘psychosis’?

Terminology in this area can be fraught with difficulty and ‘psychosis’ is not, of itself, a diagnosis. The primary care version of ICD–10 (World Health Organization, 2004) offers a condensed ICD–10 classification, with 23 diagnostic categories for use by generalists in primary care settings.

Box 15.1 The reality of living with a serious mental illness

• In 2003, while 83% of people in the UK agreed that a more tolerant attitude towards people with mental illness was needed, this still meant that nearly one in five believed there was no need to do so (Department of Health, 2003).

• Someone with psychosis is four times more likely than an ‘average’ person to have no close friends (Huxley & Thornicroft, 2003).

• In England, only 24% of people with mental health problems are currently in work (Office for National Statistics, 2003).

• Deaths from infectious diseases and endocrine, circulatory, respiratory, digestive and genito-urinary system disorders are significantly more likely for adults with psychosis (Harris & Barraclough, 1998).

• A person with schizophrenia can expect to live for 10 years less than someone without a mental health problem (Allebeck, 1989).

• Ninety-five per cent of carers are members of service users’ families (Rethink, 2003).

• Twenty-nine per cent of carers provide support and care in excess of 50 hours per week (Rethink, 2003).

• Ninety per cent of carers are adversely affected by the caring role in terms of leisure activities, career progress, financial circumstances and family relationships (Rethink, 2003).