Schizophrenia : interventions to reduce emergencies

People with schizophrenia or psychosis have relatively high rates of emergency psychiatric and non-psychiatric medical service use and suicide and people with schizophrenia average more than twice the number of visits to general practitioners as those without a mental disorder. Approximately 28% of 'high users' of acute psychiatric inpatient services carry a schizophrenia diagnosis. Almost half of all patients with schizophrenia are admitted to an inpatient facility in any given 12-month period and the use of emergency medical services among those with schizophrenia exceeds that of other mental illnesses. One means of preventing excessive service use is to provide psychosocial interventions that teach skills necessary to manage life tasks. One such intervention is a behavioural skills training programme known as Functional Adaptation and Skills Training (FAST) aimed at improving functional skills in middle-aged and older patients with schizophrenia. By promoting everyday living skills patients are expected to have reduced need for emergency medical services thereby minimizing the burden on healthcare systems. A U.S. study of 240 older people with schizophrenia compared it to group sessions where people openly discussed problems that were important to them and other group members offered suggestions and support in managing these issues. Counsellors facilitated discussion but did not offer suggestions on managing problems, except in the case of a crisis. Those in the FAST group had half the likelihood of using emergency services in general and emergency psychiatric services in particular during the course of the interventions which lasted 24 weeks. However, there was little difference between the two groups after 6-18 months suggesting that there was a need for 'maintenance' sessions to encourage the continued use of skills in patients' everyday lives.

Mausbach, Brent T. ... [et al] - Reducing emergency medical service use in patients with chronic psychotic disorders: results from the FAST intervention study Behaviour Research and Therapy January 2008, 46(1), 145-153