4.6.9.2 Routinely record the daytime activities of people with schizophrenia in their care plans, including occupational outcomes.

If there is not a rehabilitation Team in your area, then the connections in your local area that are necessary to place your family sufferer with an occupying activity of some kind, will not be worked up into a Properly this connection ought to be established and entered itno before a patient returns home or is parked somwhere else.

If there is no such coherent rehabilitation in your area, then the Trust has a Service Deficiency, and you should write and have it registered as such by the staff in the Team that is with your family mamber.

Or. if you are internet and table literate with linking try this service mapping website to find for your geographical area ... compare them to other areas [ e.g. supported housing has wide variation: Dorset lots, Cornwall none. ]
Or for your local Mental Health Trust
{ go to LIT - provider Trust area , under service group, tick 'all services' then, at bottom, click RUN REPORT
and ; or in a particular service type ... try 'continuing care' ...type ... Rehabilitation and Recovery services - the after-care service ]

Schizophrenia - when defined as having persisted in some degree of the illness for six months
- does not remit. There are going to be residual long-term problems leading to a disengaged life,
where support from the continung care in the community service becomes inadequate and inactive

Improvement to the life style of the patient is not going to happen without some kind of authoritative intervention.

That authority comes out of a staff contact which sees and conveys an identification with the patient's position now;
sees the patient as a person with a personal story, and who can see some kind of personal prospect, before them.

Another reason for this identification with the life of the person is that activities coming from 'inside'
come with the associations connected with that interest.
Activities 'imposed' coming with outside requirements, give sufferers difficulty in the getting into the sequence and detail -
the necessary and appropriate associations have to be found and held onto - this difficulty is the illness fault - and held onto
in forwarding the tasks ahead, and this is the weakness in the illness: [ what is called 'passivity' ] that other things going on around, or sometimes inappropriate connections in the mind, are not shut out sufficiently, so are tuned into, away from the matter in hand.
Or thinking just stops, to have an established routine helps.

Returning to the previous matter is poorly achieved; holding on to the guiding first instruction, loses momentum . The reminders to the job in hand are not strong enough, nor clear enough.

Sheltered practice enables the associations to be found again, maybe helps restore the brain functioningon the exterior? Maybe rebuilds the connecting mechanisms?

 

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[ some recent research ...."A fter five weeks of intensive working memory training,
in which 13 healthy male volunteers (aged 20 to 28) performed tasks that were close to their personal maximal difficulty level
for 35 minutes each day, McNab and colleagues found that working memory capacity had improved.

The change did not correlate with changes in Dopamine2 binding,
but it did correlate with Dopamine 1 binding decreases,
particularly in four of the five regions of interest
( both posterior cortices, the right ventrolateral and right dorsolateral prefrontal).
“This is consistent with the finding that low doses of a D1 antagonist
enhance the delaying activity of prefrontal neurons during the performance of working memory tasks,” write the authors.

One reservation is theoretical - how long would such a change remain, i.e., is it transient or is it fixed?
This has implications for understanding practice-related phenomena and their transfer or consolidation.
The second is technical.
A number of studies have shown that practice can change not only the magnitude of a physiologic response,
but also its location (see Kelly and Garavan for a review, 2005).

Thus, the circuitry involved in learning a task may be different
from the circuitry involved in implementing a task after it is well learned.

But it looks as though the improvement is restricted to that particular task.

[ a comment from a recent Inquiry into the services offered to a young man suffering from schizophrenia, and who came to know what he had done,
who knew that he suffered from schizophrenia,
but failed to find that sort of engagement, and went on to a perpetrate a horrific killing; and in Broadmoor killed himself " .... Goals need to be achievable rather than unattainable dreams, and failures need to be treated as correctable mistakes.
Service-providers should not punish themselves for making mistakes,
but see them as an opportunity to find out why the plan did not work and to make a better one.
If the next attempt fails, it again needs to be rectified by analysing the failure and trying something else.
And so on until, if necessary, all the creative and professional resources of the trust have been brought to bear.
Front line staff should be given the resources to work in this way" .

[ link to List of Inquiries no 225 ... and comment ]

An engagement in an outside life, that has a realisable meaning
and seems to have a realisable potential for a future commitment, takes the pressure off the domicile carer,
dilutes any oppressive relationship, and lessens rejection.

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At this stage the general mental health community teams throw in their hands,
have nothing further to offer, and leave the onus of aftercare on the ingenuity of Family and Landlords,
They have to exert what authority they can, to encourage, persuade, and sustain engagement in outside activities in a routine of commitment,
When securely in place, the programme of engagement, allows carers the ' regular breaks in the week' to use to have some balancing life of their own.

The first contact teams give up.

A good rehabilitation service, building up it's own local information background,
and it's contacts as to what is available as aftercare occupational activities at hand ,
persists with those contacts, engaging and mentoring patients
into local adult learning and education, training, interest groups, sheltered work opportunities,
using their authoritative experience and guided command from that -[ ' use your neurons or they become lost' ] - does not give up; that's it's job

There aren't that many

The patients themselves are not going to be able to realise the deficiency in aftercare ,
and the need to engage, and the need to complain and campaign.

Commissioning Primary Care Trusts are only too pleased not to have the deficiency pointed out,
thus escaping their prime responsibility to this serious and enduring mental health condition, and they deny them recurrent consideration.
As one commissioner pointed out - 'how many people are affected by schizophrenia, compared with the number in the general public affected by the 'neurotic concerns' , depressions, and anxieties; more easily understood and sympathised with, by fund controllers. The same commissioner added - ' the National Standards Framework [NSF ] for future funding decisions runs out in September 2009, replaced by 'New Horizons'.
Those with serious and enduring mental illness can no longer use the NSF for priority consideration about funding within Mental Health .

When all has been done for schizophrenia and failed - local Mental Health Trusts have given up shouting, worn out - the greater numbers - 'the worried well' - they get to the water hole first, being more active they will get any further funding

The Primary Care Trusts are not pro-active - as they should be - in finding out deficiences in service provision and listing them as unmet needs.

So as not to have the obligation to fund these UNMET NEEDS.

Let them know !!

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a Psychiatric College survey of the status of current Rehabilitation in mental health Trusts

Why have specialist Rehabilitation teams ?

Mental health services like all institutions are in power struggles for funding.

People with continuing schizophrenia do not fit in with 'normal' rehabilitation.
They cannot cope with residual illness and fulltime commitment.

Agencies are not flexible enough to welcome a 'course' with less than full time attention and attendance, where the starting ability to fit in and pacing of engagement with full time commitment to agency run projects. Agenicies are largely funded on successful targeting on the full day, full week routine: e.g. we are aiming to get them back into employment - to big an aim for this 'clientele.

A Specialist Rehabilitation service comes with at least the possibility of using Consultant power to claim resources, finds and maintains the route to bridging activity arrangements, which can be realised at various levels of commitment, below full-time work in competitive markets.

These specialist mental health areas are failing in aftercare provision, They do not have a team whose prime business is rehabilitation with a member of it who is a Consultant Psychiatrist. Avon and Witshire Bedfordshire Camden and Islington Central and NW London Cheshire and Wirral Cornwall Cumbria Herefordshire Hertfordshire Lancashire Leicestershire Manchester Mental Health and Social Services Trust Milton Keynes NE London North Essex N. Yorkshire Northants Pennine Plymouth Portsmouth Sandwell Sheffield SW Yorkhire Somerset Suffolk Tees West London 1/3 Wolverhampton 29 these do have such a team 2gether NHS FOundation [ gloucester ] 5 Boroughs ? Barnet Enfield & Haringey Barnsley Berkshire Birmingham Cambridge and Peterborough Coventry and Warwick Derbyshire Devon 1 1/2 Dorset Dudley and Walsall Greater Manchester West Humber teaching Isle of Wight Kent and Medway 1/2 Leeds LIncolnshire nurse led Merseycare Norfolk and Waveney Nottinghamshire Northumberland Tyne and Weir 1/2 Oxford and Buckinghamshire Oxleas Rotherham South Essex Partnership University South London and Maudsley South Staffs ( possibly ? ) South West London and St George's 2/3rd Surrey and Borders Sussex Walsall Teaching Worcestershire .. 35 so far awaiting confirmatory replies from Hereford ??Isle of Wight Sheffield Wolverhampton All reminded Back to Front Page .