UK National Schizophrenia Awareness Day 2022 – A mental illness in need of destigmatization

UK National Schizophrenia Awareness Day 2022 – A mental illness in need of destigmatization

July 25th is National Schizophrenia Awareness Day in the UK, aiming at shining light on “what it means to live with this much misunderstood and often stigmatized mental health condition”, fighting prejudice surrounding it, as well as seeking to raise awareness of and support for its treatment [1].

What is schizophrenia?
Individuals with schizophrenia experience disruptions in their thought processes and perceptions, as well as in social interactions and emotional responsiveness. The mental illness, usually including psychotic symptoms such as delusions and hallucinations, can be highly disabling to people suffering from it [2].

Economic costs of schizophrenia
Worldwide, around 24 million people are currently diagnosed with schizophrenia [3] – in the UK it is over 685.000 people (approximately 1% of the population) [4].
Schizophrenia has a large economic cost. It accounts for approximately “30% of all spending on adult mental health in the NHS” [5], estimated at 11.8 million GBP in England alone in 2012 [6]. Generally, it costs around 6 times as much to treat an individual with schizophrenia over its lifetime than it costs to treat a heart disease patient [5].

Stigmatization of schizophrenia
Schizophrenia affects all genders and individuals from all social backgrounds, and onsets most often in the late teenage years or in the early twenties [5]. The mental illness severely impacts affected peoples’ quality of life. In the UK, only around 13% of individuals suffering from schizophrenia are working [5], and it has been found that affected people are “2 to 3 times more likely to die early than the general population” [3]. Schizophrenia is also a significant burden that impacts productivity of family caregivers, who on average spend 22 hours a week for 15 years of their life taking care of their relative with schizophrenia.
Additionally, stigma against people suffering from the condition is still “intense and widespread” today [3]. Individuals with schizophrenia oftentimes experience social exclusion, and/or discrimination due to the disease, and some even experience limited “access to general health care, education, housing, and employment” [3]. According to the World Health Organization (2022), these issues often only exacerbate the suffering peoples’ symptoms [3].

What needs to change?
Schizophrenia is not as rare as one might think, and prejudices surrounding the illness unfortunately only further increase the burden of the disease on people suffering from it. It is therefore important to raise awareness about schizophrenia, destigmatize the mental illness, and help to ensure that individuals with schizophrenia are not facing discrimination. Given the high economic costs of schizophrenia, it is also important to continuously work on improving the treatment support provided. This includes seeking for new ways to help individuals suffering from the mental health condition.

How digital solutions for mental health can help
The use of digital platforms for remote patient monitoring and health assessment, as well as real-time patient analytics, could enable personalised treatment and improved quality of care [7]. Digital solutions for mental health could therefore offer the potential to empower and engage individuals with schizophrenia to better manage their mental health, facilitating treatment for clinical professionals and empowering family caregivers to help drive down economic costs and increase productivity.
At Monsenso, we have worked with schizophrenia in both research and clinical settings. Our digital mental health solution has helped many individuals with schizophrenia to better understand their conditions and live a more independent life, as well as helped clinicians to better support their patients. We are proud to support the National Schizophrenia Awareness Day in the UK and will continue to spread knowledge about the mental health condition and offer our support to individuals affected and clinicians providing treatment for the mental illness.
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About Monsenso
Monsenso is an innovative technology company offering a digital health solution used for decentralised trials, remote patient monitoring and treatment support. Our mission is to contribute to improved health for more people at lower costs by supporting treatment digitally and leveraging patient-reported outcomes data. Our solution helps optimise the treatment and gives a detailed overview of an individual’s health through the collection of outcome, adherence, and behavioural data. It connects individuals, carers, and health care providers to enable personalised treatment, remote care, and early intervention. We collaborate with health and social care, pharmaceuticals, and leading researcher worldwide in our endeavours to deliver solutions that fit into the life of patients and health care professionals. To learn more visit  www.monsenso.com.

References:
[1] Awareness Days (n.d.). National Schizophrenia Awareness Day 2022.
https://www.awarenessdays.com/awareness-days-calendar/national-schizophrenia-awareness-day-2022/#:~:text=National%20Schizophrenia%20Awareness%20Day%2C%20marked,with%20a%20diagnosis%20of%20schizophrenia.

[2] National Institute of Mental Health (n.d.). Schizophrenia.
https://www.nimh.nih.gov/health/statistics/schizophrenia#:~:text=Schizophrenia-,Definition,be%20both%20severe%20and%20disabling.

[3] World Health Organization (2022). Schizophrenia.
https://www.who.int/news-room/fact-sheets/detail/schizophrenia#:~:text=Schizophrenia%20affects%20approximately%2024%20million,%25

[4] Royal College of Psychiatrists (2015). Schizophrenia.
https://www.rcpsych.ac.uk/mental-health/problems-disorders/schizophrenia

[5] Living With Schizophrenia (2017). Facts and Figures.
https://livingwithschizophreniauk.org/facts-and-figures/

[6] Ride, J., Kasteridis, P., Gutacker, N., Aragon Aragon, MJ., Jacobs, R. (2020). Healthcare Costs for People with Serious Mental Illness in England: An Analysis of Costs Across Primary Care, Hospital Care, and Specialist Mental Healthcare. Appl Health Econ Health Policy 18(2):177-188.
doi: 10.1007/s40258-019-00530-2.

[7] Elsevier Health (2022). Clinician of the Future Report 2022.
https://www.elsevier.com/connect/clinician-of-the-future

Monsenso signs two contracts with the Psychiatric Research Unit, Region West Zealand.

Monsenso signs two contracts with the Psychiatric Research Unit, Region West Zealand.

Monsenso signs two contracts with Research Unit for Psychotherapy and Psychopathology, Psychiatry West, Slagelse, Region Zealand Mental Health Services, who will use Monsenso’s digital health solution to remotely monitor patients with depression and schizotypal mental illness, respectively.

The first project, Development of an Intervention for Persistent Not on Track: DIP NOT, led by Jasmin Rejaye Gryesten, aims to identify non-responders to depression treatment, with the ultimate goal of increasing the number of remitted patients after CBT in the Danish MHS by developing a set of new person-centered add-on interventions to group CBT, to be used in case of observed lack of progress or deterioration.

The second project Phenomenologically informed PsychoTherapy for patients with Schizotypal Personality Disorder (PPT -SPD), is led by Kåre Donskov Nielsen and aims to develop and test new forms of phenomenological therapy that can help people with schizotypal mental illness.

About Monsenso
Monsenso is an innovative technology company offering a digital health solution used for decentralised trials, remote patient monitoring and treatment support. Our mission is to contribute to improved health for more people at lower costs by supporting treatment digitally and leveraging patient-reported outcomes data. Our solution helps optimise the treatment and gives a detailed overview of an individual’s health through the collection of outcome, adherence, and behavioural data. It connects individuals, carers, and health care providers to enable personalised treatment, remote care, and early intervention. We collaborate with health and social care, pharmaceuticals, and leading researcher worldwide in our endeavours to deliver solutions that fit into the life of patients and health care professionals. To learn more visit  www.monsenso.com.

For additional information contact:
Bettina van Wylich-Muxoll
Chief Marketing Officer
marketing@monsenso.com
Monsenso

A holistic approach to treating schizophrenia

A holistic approach to treating schizophrenia

Over the last few decades, there has been a shift in the way we think about mental illness, particularly schizophrenia. Until quite recently, schizophrenia was considered as an illness with a poor prognosis, offering little hope of living a fulfilling life. However, over the last two decades, research has shown that early and appropriate intervention can change the course of mental illnesses such as schizophrenia.

Schizophrenia was previously considered a shattering illness because it usually appears during the late teens or early twenties. At this point in life, young people are finishing their education or entering the workforce, exploring romantic relationships, and becoming independent. Disrupting this normal developmental trajectory, rather than the symptoms of the illness alone, is what has such a severe impact on young people suffering from schizophrenia.

However, studies have revealed that schizophrenia doesn’t appear suddenly; it usually has an onset after a long period of severe symptoms. Certainly, much of the disability associated with psychotic illnesses develops before the first episode of illness.

In the early 1990s, researchers conducted the first studies of early intervention in psychosis, and the results revealed that early and appropriate treatment led to better long-term outcomes for young people. This work resulted in the discovery that early and adequate treatment allows young people to make a complete recovery, with less ongoing disability, and for the first time clinicians considered that schizophrenia was not as hopeless as they once thought.

This discovery generated interest worldwide, and the ‘early intervention’ movement was born. Early intervention for severe mental illnesses aims to prevent the onset of illness, minimise the symptoms associated with the illness, and to maximise the chances of recovery.

Practically speaking, preventing the onset of a mental illness consists of determining who is at risk and then deciding how to intervene in order to prevent the illness. Unfortunately, we currently do not understand the biology of mental illnesses well enough, and much more research needs to be done to enable clinicians to develop diagnostic tests that are sufficiently accurate and concrete. What we do know at present is that most mental illnesses appear when individuals are between 14 and 29 years old, and seeking help for distressing symptoms is crucial to recovery.

Recognising that this group of young people is at high risk of developing a severe mental illness has allowed clinicians and researchers to develop some treatment approaches aimed at relieving their symptoms and preventing the onset of a more serious illness. This type of treatment is tailored to an early stage of the illness, and it likely includes counselling, education and supportive monitoring. If symptoms deteriorate, cognitive behavioural therapy may be offered, combined with antidepressants and anti-anxiety medication. Low-dose antipsychotics have also been tested in this patient group but are not recommended as a first line of treatment due to the adverse side-effects.

The early intervention and careful monitoring are crucial for these young people, because although many of them will not develop schizophrenia, their symptoms have the potential to evolve into a more severe mental illness if they are not treated effectively at an early stage.

For those young people who do experience a first episode of psychosis, the illness needs to be promptly recognised and treatment should be given as early as possible. Initial treatment involves low-dose antipsychotic medication to manage their symptoms. Yet, recovery involves more than just eliminating symptoms; it also means maintaining or regaining their normal developmental pathway—getting back to work or school, enjoying social activities, and moving on into becoming independent.

Subsequently, these young people and their families need to be able to rely on a comprehensive, integrated care system involving a continued case management team providing medication and psychological treatment to help them manage their symptoms and illness. This type of care should be provided for the first 2–5 years after the onset of the illness when there is a greater risk of becoming permanently disabled.

The care system should offer a youth-friendly, and inclusive environment where young people can be supported in their recovery by a multidisciplinary team with specialist medical, psychosocial, vocational and educational expertise in mental health.

This treatment approach, besides being much more cost-effective, has been very effective for young people in the early stages of illness and is highly valued by the young people and their family caregivers.

The importance of mental health issues, together with the demand for mental health services that recognise young people’s unique mental health care needs, have led to new service development in countries like Australia, Denmark, England, Ireland, Canada, and the United States.

For example, in 2006, the Australian Government established a national primary care youth mental health system which is now operating in 70 sites across the nation, with 30 centres to be added in 2016.

This approach offers holistic care from the beginning, and young Australians are gaining access to early intervention and evidence-informed, stigma-free care for mental health. Young people and their families deserve to be actively engaged and receive evidence-informed care in accordance to their needs. This type of care facility has shifted our thinking in mental health care offering better outcomes for young people, their families, and our society as a whole.

Another example is Denmark. The different healthcare regions in Denmark are taking advantage of new technologies such as mobile health (mHealth) solutions to support the treatment and remotely monitor young patients suffering from mental illnesses such as bipolar disorder, major depressive disorder, anxiety, and post-traumatic stress disorder amongst others.

For instance, the Southern Denmark Region is using the Monsenso mHealth solution to support the treatment of individuals suffering from borderline personality disorder undergoing Dialectic Behavioural Therapy (DBT), and other affective disorders – such as schizophrenia.

The Monsenso solution has incorporated the Diary Cards traditionally used in DBT into an electronic format that can be accessed by patients through their smartphones. The solution enables patients to fill in Clinical Questionnaires relevant to their disorder through their smartphone, capturing data electronically.

Reference:

Living with Schizophrenia. World Federation for Mental Health. 2014. http://wfmh.com/wp-content/uploads/2014/09/WMHD_English.pdf

The importance of early intervention in the recovery process

The importance of early intervention in the recovery process

Early intervention is critical to treating mental illness before it can cause tragic results such as serious impairment, unemployment, homelessness, poverty, and suicide [1].

The identification of mental illness and its treatment, as early as possible, represents a high priority. The early detection and treatment of mental illness promote recovery, independence, and self-sufficiency, as well as facilitating social activities and employment opportunities [2].

It is estimated that 100,000 adolescents and young adults in the United States alone experience a first episode of psychosis every year. The early phase of psychotic illness is widely viewed as a critical opportunity for indicated prevention, and a chance to alter the downward trajectory and poor outcomes associated with serious mental disorders such as schizophrenia. The timing of treatment is critical; short and long-term outcomes are better when individuals begin treatment close to the onset of psychosis. Numerous studies find a substantial delay between the onset of psychotic symptoms and the initiation of treatment. In the U.S., treatment is typically delayed between one and three years, suggesting that many people experiencing first episodes of psychosis are missing a critical opportunity to benefit from early intervention [3].

Early identification and rapid referral are essential to shortening the duration of untreated psychosis and pre-empting functional deterioration. The World Health Organization advocates reducing the duration of untreated psychosis to three months or less by addressing “bottlenecks” in the pathway from early psychosis identification to initiation of specialty care [3].

To support early intervention, in 2009, the National Institute of Mental Health (NIMH), implemented a research project to change the prognosis of schizophrenia through aggressive treatment in the earliest stages of illness.Recovery After an Initial Schizophrenia Episode (RAISE) is designed to reduce the likelihood of long-term disability that people with schizophrenia often experience. It aims to help people with the disorder lead productive, independent lives. At the same time, it aims to reduce the financial impact on the public systems often tapped to pay for the care of people with schizophrenia [4].

In 2011, RAISE began conducting a full-scale, randomized controlled trial comparing two different ways of providing treatment to people experiencing the early stages of schizophrenia and related disorders. Both types of treatment emphasize early intervention but feature different approaches for initiating and coordinating care. Treatment may include personalized medication treatment, individual resiliency training, and supportive services, such as family psychoeducation and education or employment assistance [5]. The RAISE study, expected to be completed by August 2016, aims to emphasize the importance of early intervention.

The Monsenso mHealth solution can help healthcare providers to closely monitor patients who have experienced a first episode of mental illness.

After experiencing a first episode, the healthcare provider can encourage the patient to use the Monsenso mHealth solution. This will enable the clinician to monitor the individual on a continuous basis, and react if symptoms arise.

With the Monsenso user app, patients can fill in self-assessments on a daily basis. These self-assessments include information on the patient’s behaviour and symptoms related to his mental health. Furthermore, the solution collects sensor data through sensors in the patient’s smartphone, and this combined with the self-assessment will help the healthcare provider to continuously monitor the patient, and support intervention at a very early stage. Early warning signs and automatic triggers can be set to indicate to the health care provider that proactive intervention is needed, if for example a patient sleeps too little or feels too distressed.

Early intervention and continuous monitoring can maximize a person’s chances of a fast recovery, self-sufficiency, and living a high-quality life including the possibility to pursue and education and maintain a stable job.

References:

[1] Directors Blog: SAMHSA and NIMH partner to support early intervention for serious mental illness. P. Hyde and T. Insel. National Institute of Mental Health Blog (2014, June 17) http://www.nimh.nih.gov/about/director/2014/samhsa-and-nimh-partner-to-support-early-intervention-for-serious-mental-illness.shtml

[2] Early intervention and recovery for young people with early psychosis: consensus statement. J. Bertolote and P. McGorry. British Journal of Psychiatry (2005). http://bjp.rcpsych.org/content/bjprcpsych/187/48/s116.full.pdf

[3] Evidence based treatment for first episode of psychosis: Components of coordinated specialty care. PHD R. K. Heinssen. RAISE NIMH (2014, April 14). http://www.nimh.nih.gov/health/topics/schizophrenia/raise/nimh-white-paper-csc-for-fep_147096.pdf

[4] Raise Project Overview. National Institute of Mental Health. (2009)http://www.nimh.nih.gov/health/topics/schizophrenia/raise/index.shtml

[5] NIMH RAISE Project makes progress as team refines research approach. National Institute of Mental Health. (2011, August 9) http://www.nimh.nih.gov/news/science-news/2011/nimh-raise-project-makes-progress-as-teams-refine-research-approaches.shtml