Schizophrenia-Time-to-Commit-To-Policy-Change-Updated-Report-2024

This activity is supported by an independent medical educational grant from Boehringer Ingelheim
International GmbH, and an unrestricted educational grant from H.Lundbeck A/S. Neither organisation
have had inuence on, or input into the development or the performance of this activity.
Silvana Galderisi
Davi Kaur 
Péter Kéri
Belinda Lennox
Stephen Marder
Tina Matthews-Hayes
David McDaid
Sabine Müller
Fiona Nolan
Merete Nordentoft
Dainius Pavalkis
John Saunders
Tomiki Sumiyoshi
Schizophrenia – Time to
Commit to Policy Change
Updated Report 2024

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© 2024 Oxford Health Policy Forum CIC. Licensed under the Creative Commons Attribution-
NonCommercial-NoDerivatives 4.0 International Licence. To view a copy of this licence,
visit http://creativecommons.org/licenses/by-nc-nd/4.0/
Oxford Health Policy Forum CIC is a not-for-prot community interest company registered
in England and Wales (registration number: 10475240). Oxford Health Policy Forum CIC is
dedicated to the development of policy initiatives that aim to achieve the best possible
outcomes for people living with lifechanging conditions and for those who care for them.

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Preface 04
Authors and contributors 06
Executive summary 07
Recommendations for change 09
About schizophrenia 10
n What is schizophrenia? 10
n The symptoms of schizophrenia 10
n What causes schizophrenia? 11
n Diagnosis of schizophrenia 12
The impact of schizophrenia 13
n The impact on people with schizophrenia 13
n The impact of schizophrenia on caregivers and families 16
n Socioeconomic impact of schizophrenia 17
The patient pathway 20
n The schizophrenia patient journey 20
n The goal of treatment: towards recovery 21
Scientic advances in schizophrenia 22
n Advances in diagnostics 22
n Advances in new drug targets and brain stimulation interventions 22
n Advances in adherence to antipsychotic medicines 24
Treatments for schizophrenia 25
n Introduction 25
n Antipsychotic medications 27
n Psychosocial therapies 29
n Management of co-morbidities 34
The policy landscape for schizophrenia 36
n Historical context 36
n Today 37
What more can be done? 41
n Treatment 41
n Going beyond treatment 42
n Taking care of the caregiver 44
n Empowering people with schizophrenia 45
n Start somewhere: inspirational cases for every setting 47
Abbreviations 50
References 51
Contents

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Preface
Schizophrenia is recognised as one of the most complex mental health disorders, entwined in both misconceptions
and truth. Historically, those diagnosed with schizophrenia have been subjects of both fear and admiration, with
their lives often marked by signicant challenges, including early mortality. Nonetheless, individuals like Swedish
musician Ted Gärdestad, mathematician John Nash, and writer Zelda Fitzgerald have made remarkable contributions
in elds such as art, music, mathematics, and science, demonstrating exceptional talent amidst their struggles.
During my time at university, a friend shared his experiences with psychotic episodes — tumultuous journeys
often culminating in disaster, and the vital role mental health professionals played in his recovery. This period
coincided with Sweden’s phasing out of its last mental health institutions, a move debated sparingly at the time.
We now understand that deinstitutionalisation, often executed without adequate alternative care, led to severe
consequences for many. Although care standards have improved, people with schizophrenia still face a reduced
life expectancy, emphasising the need to address their specic requirements in mental health care and policy
discussions.
First published in 2014, this report arose during an era when mental health was perceived as a static eld. More
recently, I’ve observed a revival in the importance of mental health policy, largely driven by the onset of COVID-19
and an increasing awareness of the interconnection between mental and physical health. This has propelled
mental health on the policy agenda. Organisations like the EU and WHO, along with various countries, now regard
mental health care as a priority. The realisation that mental health challenges can aect anyone, together with the
acknowledgment of the advantages of mental health awareness in the workplace and the clear link between mental
and physical well-being, has fuelled this positive shift in policy.
However, amidst these broader changes in mental health policy, there’s a risk that the distinct needs of those with
severe mental illnesses, such as schizophrenia, might be overshadowed. We all acknowledge the benets, both
individual and societal, of addressing mental health through legislation and guidelines. The question remains: does
this eort adequately cover the requirements of severe mental illnesses? The approach undoubtedly requires more
complexity. It needs to be comprehensive, encompassing policy formulation, treatment guidelines, and scientic
innovation, all working together to facilitate real advancement.
The authors of the original report played a pivotal role in raising the prole of mental health in policy discussions.
I express my profound gratitude to them and to the 13 authors of this latest version. Their exceptional expertise in
mental health, particularly in schizophrenia, oers invaluable insights into advancements in science, healthcare, and
policy. Their dedication and empathy have been evident throughout the development of this report.
Innovation in neuroscience, especially in drug research and development, continues to be a challenging and
intricate eld. We are grateful to organisations like Lundbeck and Bohringer Ingelheim for not only sustaining their
interest in advancing this area but also providing independent educational grants to promote knowledge in this
eld. These contributions have been essential in facilitating the creation of this report.
This report delves into the specic needs of people with schizophrenia, exploring supportive measures for their
welfare. While it may be too late for some, like my university friend, it’s never too late to initiate change. This is
highlighted by our practical and achievable recommendations for change. Our message to all nations, policy makers,
payers, and healthcare professionals is unequivocal: aim for excellence, but most importantly – start somewhere!
Kajsa Wilhelmsson, LLM and MSc
Acting Director, Oxford Health Policy Forum CIC.

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A word on language
How best to refer to people with schizophrenia is an emotive and sometimes controversial, question. The word
‘patient’ is appropriate in a medical context, but may be too clinical for a person living in the community. Terms
such as ‘service user’, ‘client’ and ‘consumer’ are used in some countries and settings, but they often do not
translate well elsewhere. In this report, the authors have chosen to use the word ‘patient’ when the setting is
strictly clinical, but ‘person with schizophrenia’ (or similar) is used in other contexts.
This publication is available to view and download online at the Oxford Health Policy Forum CIC:
https://www.oxfordhealthpolicyforum.org/our-work/schizophrenia/