Social aspects see Chapter

First episodes of schizophrenia have in the past routinely received inpatient treatment; however, some can be dealt with in the community if there are adequate community mental health services, supplemented perhaps by a crisis team. Emergency admission, sometimes under the Mental Health Act 1983, may be required for acutely disturbed patients.

After acute symptoms are under control, most patients will be able to be discharged home, and the aim should be to resume normal life including going back to work as soon as possible. Other patients with practical impairments in, for example, ability to look after themselves, may need a period of rehabilitation, including guidance in work, practical aspects of daily living, behavioural modification, and social skills.

In the past, many patients spent the rest of their lives in the chronic wards of large mental hospitals, but such institutions have now almost entirely closed down. Most patients are now managed by community mental health teams working in collaboration with primary care. Warden-controlled flats, hostels, or group homes provide a suitable environment for those who cannot live independently or with their families, and day centres or voluntary work offer rehabilitation activity.

Some patients, however, live rough, or in unsupervised lodgings, either because no suitable accommodation can be found for them, or because they reject offers of help. They are easily lost to follow-up especially in inner-city areas, and, in the absence of medical or social care, there is a serious risk of self-neglect, self-harm, and occasionally of violence to themselves or others.

Use of the care programme approach (see Chapter 25), in which high-priority cases are monitored through a register and each patient has a named key worker, should enable medical and social care to be coordinated and maintained.

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