Community-Based Care - Schizophrenia

COMMUNITY-BASED CARE

Clients with schizophrenia are no longer hospitalized for long periods. Most return to live in the community with assistance provided by family and support services. Cli-ents may live with family members, independently, or in a residential program such as a group home where they can receive needed services without being admitted to the hospital. Assertive community treatment programs have shown success in reducing the rate of hospital admissions by managing symptoms and medications; assisting clients with social, recreational, and vocational needs; and pro-viding support to clients and their families. The psychiat-ric nurse is a member of the multidisciplinary team that works with clients in assertive community treatment pro-grams, focusing on the management of medications and their side effects and the promotion of health and well-ness. Behavioral home health care also is expanding, with nurses providing care to persons with schizophrenia (as well as other mental illnesses) using the holistic approach to integrate clients into the community. Although much has been done to give these clients the support they need to live in the community, there is still a need to increase services to homeless persons and those in prison with schizophrenia.

Community support programs often are an important link in helping persons with schizophrenia and their families. A case manager may be assigned to the client to provide assistance in handling the wide variety of chal-lenges that the client in community settings faces. The client who has had schizophrenia for some time may have a case manager in the community. Other clients may need assistance to obtain a case manager. Depending on the type of funding and agencies available in a particular community, the nurse may refer the client to a social worker or may directly refer the client to case manage-ment services.

Case management services often include helping the client with housing and transportation, money manage-ment, and keeping appointments as well as with socializa-tion and recreation. Frequent face-to-face and telephone contact with clients in the community helps address cli-ents’ immediate concerns and avoid relapse and rehospi-talization. Common concerns of clients include difficulties with treatment and after-care, dealing with psychiatric symptoms, environmental stresses, and financial issues. Although the support of professionals in the community is vital, the nurse must not overlook the client’s need for autonomy and potential abilities to manage his or her own health.