Distal support and schizophrenia : putting the care back into community

Since the policy of closing down long-stay psychiatric hospitals and re-integrating people into the community was introduced there has been a lot of research into the best way of helping people settle into the community. This has concentrated on employment and support networks such as friends and families but much less research has been done in the field of casual, routine interactions with other members of the public such as might occur in shops, libraries, gyms, churches etc and which is known as 'distal support'. A study of 58 people with schizophrenia in the U.S. found that extroversion and openness were important in how much distal support a person received, regardless of how severe their symptoms were. Those who received the most distal support also reported a higher quality of life and a greater sense of belonging in their neighbourhood. However, those people who reported high levels of distal support were also more likely to be hospitalized. The researchers speculated that this could be because : i) the more contact people had with others in the community the more likely it was that someone would suggest that they get help when their symptoms worsened ii) that some of the interactions that the people with high distal support had with others in the community were negative and made their symptoms worse or iii) that the extroversion and openness that made people likely to have high levels of distal support also made them more likely to seek help when they felt that their condition was worsening.

Wieland, Melissa E. ... [et al] - Distal support and community living among individuals diagnosed with schizophrenia Psychiatry Spring 2007, 70(1), 1-11