Feature and interview from the May/Jun issue of The OT Magazine

Schizophrenia is a severe, long term mental health condition which causes a range of different psychological symptoms.

Doctors often describe schizophrenia as a type of psychosis. This means the person may not always be able to distinguish their own thoughts and ideas from reality.

Symptoms of schizophrenia include: hallucinations (hearing or seeing things that don’t exist); delusions (unusual beliefs not based on reality); muddled thoughts which are based on hallucinations or delusions; and changes in behaviour. Some people think schizophrenia causes ‘split personality’ characteristics or violent behaviour. This is not true. The cause of violent behaviour is usually drug or alcohol misuse.

The cause of schizophrenia is unknown, but most experts believe the condition is caused by a combination of genetic and environmental factors.

It is thought that some people are more vulnerable to developing schizophrenia and certain conditions can trigger the symptoms.

It is usually treated with a combination of medication and therapy tailored to each individual. In most cases, this will be anti-psychotic medicines and cognitive behavioural therapy.

Many people recover from schizophrenia, although they may have relapses – but the chances of this are reduced if schizophrenia is well managed.

Interview: Marion Findlay

Marion Findlay is Director of Services at Volunteer Edinburgh and is responsible for a range of services which promote personal development through volunteering.

She is a member of the public affairs committee of Support in Mind Scotland, a national charity with particular expertise in understanding schizophrenia and psychosis and the impact this has on families.

Marion previously worked as an occupational therapist in a variety of mental health settings in Lothian. Volunteer Edinburgh works in partnership with a number of voluntary organisations across the city, all working on a recovery-based model.

In 1983, Volunteer Edinburgh became the first volunteer centre in Scotland to specifically work with people who have experience of mental illness and support them to be active volunteers in the community.

How would you describe public perception of schizophrenia?

Schizophrenia is the last taboo. It is an illness that conjures fear and misunderstanding of what the condition is about. Many of the misconceptions have been shaped by exaggerated portrayal of the condition in books and horror movies, which can be damaging.

Schizophrenia is a term that is often misused to describe or depict the illness in a dangerous or thrill-seeking way.

People who have schizophrenia often require a different type of support from those who have other mental illnesses.

Everyone feels down or anxious at times, but not everyone can empathise with what it is like to hear voices in your head or have paranoid beliefs that affect your thinking about yourself and about other people.

It is an illness that can really cut an individual off from other people and society.

Recent years have seen a sea change in the perception of and attitudes to mental health. The involvement in recent months of the Duke and Duchess of Cambridge and Prince Harry with the Heads Together charity has made great inroads in the campaign to end stigma around mental health and change the national conversation on mental health and wellbeing.

National charity Support in Mind Scotland has specific expertise in understanding and responding to serious mental ill-health. It campaigns for a stronger voice for anyone whose mental health problems or mental illness has a serious impact on their life and on the lives of family members, friends and supporters.

Support in Mind Scotland knows that stigma and discrimination is still one of the biggest barriers people face to getting the support they need when they need it, so raising awareness and understanding is an important aspect of its policy work.

How do OTs assist people with schizophrenia?

Much of what we do at Volunteer Edinburgh is intrinsically linked with OTs working in psychiatric hospitals and within community teams to ensure people have meaningful days and a clear purpose in the occupations in which they are involved.

Studies have shown that occupational therapy is a key component in the successful treatment of schizophrenia, as well as other serious mental health disorders.

Alongside psychiatrists, psychologists, nurses and social workers, OTs offer patients essential help navigating social and work situations and so bolster patients’ confidence and independence to integrate into their communities.

Effective assessment by an OT provides information on the occupational functioning of a person. By assessing, intervening and advocating for a person, an occupational therapist can contribute to developing a central role in the field of early psychosis.

The key ways an OT can assist people with schizophrenia is to help them to identify the occupations and relationships that matter to them and the skills and abilities they require to lead a purposeful life.

OTs help to establish basic community living skills, having a meaningful routine and being engaged in activities that support social inclusion.

This can prevent isolation, give individuals a stronger sense of worth and self-esteem and enables them to live the best life they can.

How does your OT-directed work impact the lives of people with schizophrenia? 

Our team at Volunteer Edinburgh work with people to identify volunteering activities they would like to do and to support them to get involved. This can be in the community or in hospital if they are an inpatient.

Psychosis strips people of their sense of self-worth. Volunteering is a way they can become a ‘contributor’ rather than always a ‘recipient’ – so has massive benefi ts for self-esteem and confidence.

For the past 30 years we have been running our health and wellbeing project and have been inspired and humbled by the way that people with schizophrenia have become active citizens helping their local community in numerous ways.

The personal benefi ts are extensive – improvements in their health and wellbeing, increased employability, a wider circle of contacts and networks. Some people have relapses and have to stop volunteering for a period, but in many cases build a resilience and have a role to return to when things improve.

Another of our services is the Volunteer Hub at the Royal Edinburgh Hospital, where inpatients who have fluctuating health or cannot leave the hospital for legal reasons get involved in inpatient volunteering opportunities. We also manage a strong team of public volunteers who are invaluable.

Occupational therapists are the conduit for virtually everything we do at the hospital. They set the direction for how we engage with the patients. You could say that everything we do has the finger print of occupational therapy on it as they have the expertise to identify patients’ skills and talents and the support they need on an on-going or short-term basis.

They also help people to take positive risks in trying out new and varied activities.

What are the first steps to helping a client who has schizophrenia? 

I’d say it’s getting to know the individual and getting to know what inspires them or inspired them in the past. What have they done in their life that has given them a sense of worth, or what would they like to do to achieve that?

It’s about finding the potential to take things forward, such as being independent in daily living, shopping, cooking, cleaning and forming good relationships with people and taking part in activities like learning a foreign language, playing music or sport or developing new skills in IT or arts.

OTs work with patients to identify how they will do that and give them the support they need, working in a graded way – small steps to bigger, long-term aspirations.

How important is OT to people with schizophrenia and how does it benefit the client?

Massively important. It is so person-centred and purposeful. They can help people with schizophrenia be engaged in the kind of everyday things everyone does – purposeful occupation in its true sense.

I have a real belief that as individuals, we really need to have purpose. It is very difficult to motivate yourself to function if you do not have a reason to get out of bed or if everything you do is slightly meaningless or tedious. People who have schizophrenia often experience this.

As OTs, we have a real ability to help people with schizophrenia  build confidence and have a sense of worth that has a positive impact not only on themselves but on other people as well.

 For more information please visit www.supportinmindscotland.org.uk or www.volunteeredinburgh.org.uk

Feature and interview from the May/Jun issue of The OT Magazine, copyright The OT Magazine.