very limited. All I know is the 5% in employment and education figure
for people with schizophrenia (Epsilon study though I've not read the
paper; it's one of the lowest rates in Europe). Oh and the info about
one of the root causes of the overdiagnosis of black people. Frankly I
don't feel my input is worth something unless I know my stuff. I've
spent over 2 years learning a lot about schizophrenia. (Never had the
diagnosis. Was diagnosed with schizoaffective ages ago but my last
diagnosis is mixed affective disorder and the last psychiatrist I saw
didn't give me a diagnosis).
In terms of equality the only thing I'd suggest would be based around
employment. This sort of forces the severely mentally ill back into
public sight. It's applied social contact theory which I feel is going
to be the only real way to make a change. An employment scheme linked to
something like Affirmative Action would be my suggestion for what will
benefit the equality of the mentally ill in the long term. It's very
simplistic though.
People with sz may still face the stigma without people's attitudes
truly changing in the short term. They'll continue to suffer from the
things which can't be controlled, i.e. how people talk about them behind
their back or how they're treated less well because they seem mad or
react in unusual ways. The individuals would suffer and this is not what
I want but without their sacrifice the root stigma of mental illness
will never change.
During the creation of the asylum system (The Great Confinement as
Foucault calls it) the expression of madness became hidden for
generations. People forgot that madness is normal in developed world
nations and the systems and cultures evolved without it. Medication
arrived and it continued the confinement. Remember: the meds don't help
the core pathology, i.e. the delusions and hallucinations. They just
suppress the expression of behaviour. Madness is still hidden and
society continues to expect that people aren't a bit crazy. The Great
Confinement is probably a major part of the WHO IPSS result, the one
which shows on 2, 5 and 10 year follow up (and has been replicated)
people in the developing world with schizophrenia do better on social
and clinical outcomes than those in the US and UK. Developing world
nations never experienced the Great Confinement though as they become
influenced by the methods of Western psychiatry they may find they too
start to see a worsening in clinical and social outcomes (social
includes occupational I think).
I think many people with schizophrenia are resistant to going back to
work and I think NICE are unlikely to commission an Affirmative
Action-bnased employment scheme. Sadly I just don't see how any change
is going to be made unless it is mandatory for organisations to fulfil
their equality duty. I suspect if anyone surveyed the national mental
health charities to see how many people with schizophrenia work there
(paid work) and how many of their senior management tier have ever been
diagnosed with schizophrenia or, perhaps more simply, have ever been
sectioned under the Mental Health Act 1983 I think we'd find a lot of
them aren't living up to their mission statements. I'm sure this would
be true of NICE, the Department of Health and many other healthcare
organisations. Wouldn't that be an interesting survey eh? The idea of
sectioning as a proxy for severe mental illness separates the wheat from
the chaff, i.e. it imposes a hierarchy of disability.
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