Schizophrenia: offering support and overcoming barriers

Schizophrenia is a serious mental illness that is estimated to affect roughly 1 in 100 people in Australia. People with schizophrenia may experience drastic changes or irregularities with their behaviours, perceptions, and interactions with the world. Their thinking may be distorted, and their sense of reality may be challenged. At its extreme, the condition can result in periods of psychosis – this can be particularly debilitating.

People with schizophrenia face double the challenge, first in their experiences with the illness itself and secondly in combating the misunderstandings and stigma that are sadly common in the community. Yet early detection of the illness, and the right mix of clinical and community supports can help people with schizophrenia to manage their symptoms, and live full lives. By separating fact from fiction, and having the knowledge and confidence to offer support, you can help to make life better for someone with schizophrenia. 

What is Schizophrenia?

Schizophrenia is a complex mental illness. It can cause a person to experience a range of symptoms that affect thinking and behaviours. People with schizophrenia also experience periods of psychosis. Psychosis refers to a state where a person loses touch with reality, with significant impairments to thinking, feeling, perception and behaviour. Psychosis is quite debilitating. It can also cause a range of other symptoms that can impact cognitive function, wellbeing and general enjoyment of life.

Diagnosis and treatments of schizophrenia have improved greatly over the years, and outcomes are far better than they have been historically. Diagnosis can still be difficult, but medical professionals can track early symptoms over time to intervene more quickly than ever before. By testing medications, early effective management is easier. Without the correct supports and treatments, symptoms will typically worsen over time, however it is important to note that schizophrenia is treatable.

A single or exact cause for schizophrenia is still unknown. While there is a heredity or genetic link, certain stressors, circumstances and lifestyle factors can put someone at greater risk of developing psychosis, if they are already vulnerable to the illness. Some of these risk factors include: extreme stress, trauma, abuse, and harmful alcohol or other drug use.

A person will need diagnosis and care by medical and psychiatric professionals, and treatments will usually include combinations of prescribed medications (such as anti-psychotics), talk therapies and community supports.

What are the signs and symptoms?

Symptoms of schizophrenia most commonly develop during late adolescence or early adulthood and become lifelong – even if they come and go. However, some people may be diagnosed during childhood or later in life. The primary feature of schizophrenia is psychosis. Symptoms of psychosis may be clinically categorised as ‘positive’ (things the person might start experiencing), ‘negative’ (things the person might stop doing or be unable to do), and ‘cognitive’ (the way the person’s brain works and processes information).

During psychosis, a person may have extreme and erratic thinking and behaviours, and have trouble knowing what is real and what is not. This can affect their decision-making, interactions with the people and world around them, and their personal safety.

Like any mental illness, the way in which schizophrenia presents can differ from person to person. Episodes of schizophrenia symptoms can be continuing or relapsing, and a person with schizophrenia is not necessarily always experiencing psychosis. Many may struggle with the illness long term, while some may have briefer episodes at certain points in their life. For some people the onset can be rapid, while for others it may develop over time with subtle changes. 

Common symptoms during psychosis:

• Hallucinations (e.g. hearing or seeing things that are not real).
• Delusions or breaking away from reality (fixed false beliefs, e.g. someone believing themselves to be under observation or being persecuted in some way).
• Disordered thinking.
• Strange behaviour, beliefs, and perceptions.

Other symptoms:

• ‘Flat affect’ – lack of expression, monotonous speech, lack of interest in daily activities and interactions, and slow or laboured movements.
• Cognitive symptoms – trouble thinking clearly, paying attention, making decisions, focusing or remembering things.
• Lack of pleasure and enjoyment in life – feeling low, depressed or unmotivated, or withdrawing from contact.
• Sleep disturbances and neglect of physical health requirements such as diet, hygiene and self-care.

Risks of suicide:

• Not all people with schizophrenia will experience suicidal thoughts or engage in any kind of self-harm; however, it is not uncommon. Intervention is essential in an emergency situation – see our Mental Health First Aid Guidelines for Suicidal Thoughts and Behaviours.Self-harm may include:
  • Non-suicidal self-injury – actions that intentionally cause harm to the body with no suicidal intent.
  • Suicidal ideation – thinking or talking about suicide.
  • Suicide attempts – the person has taken action to try to end their life.

Safety concerns:

In rare cases the person may act in a way that endangers them, for example by running away from a hallucination that has frightened them. This is not suicidal behaviour but could still result in serious harm.People with schizophrenia are not typically a risk to others and are more likely to experience physical assault and other forms of violence from someone else. However, in rare situations, a person may engage in behaviour that puts someone else at risk. This is usually due to fear during hallucinations or delusions.  In these situations, it is important to also take steps to keep yourself and others safe.

The trouble with myths, misconceptions and stigma

Schizophrenia is an often poorly understood mental illness. This is both the case amongst the public and even health professionals. The myths, misconceptions and stigma that surround the illness can be damaging. They negatively impact both individuals and broader understanding of the illness. This can lead to additional distress for those with schizophrenia – making it harder to deal with their illness and lead normal lives.

It can also lead to challenges in diagnosis and treatment, especially if the person feels shame about seeking support. With the right supports and treatments, people with schizophrenia can be active participants in families, education, employment, social groups and the broader community.

Facts that can help bust the myths

• People with schizophrenia come from all walks of life. They can lead productive and happy lives, and have just as much to offer the world around them as anyone else.
• People with schizophrenia do not have a ‘split personality’ or ‘multiple personalities’. Schizophrenia is often mistaken for other mental disorders or incorrectly labelled.
• People with schizophrenia are not to be feared. There is often a false claim that they are dangerous or violent. Only a small percentage of people with schizophrenia may become violent while experiencing psychosis. They are more likely to be a danger to themselves or to experience violence from others.
• People with schizophrenia can also be intelligent, talented, funny, engaging, courageous, and loving – they are not simply defined by their illness.
• People with schizophrenia need a mix of evidence-based treatments and medical care to get better. Simple lifestyle changes, alternative remedies or ignoring the illness will not make it go away or get better. Don’t ask a person with schizophrenia to ‘just try harder’ to manage symptoms, ‘feel better’, ‘snap out of it’, or ‘think rationally’.
• People with schizophrenia did not ‘do something wrong’ to invite or deserve their illness. All mental illnesses emerge in response to a complex interaction of biological, psychological and social factors. Seeking to lay blame or determine the cause doesn’t help the person to feel better or improve outcomes.
• People with schizophrenia are hurt by stigmatising and derogatory language, whether directed at them or generally. Avoid terms like ‘schizo’, ‘pscyho’, ‘crazy’, ‘nuts’. Talking about schizophrenia in accurate, medical terms should be normalised.

What you can do to help:

As someone who can provide mental health first aid or other forms of support to someone who is struggling, you will never be expected to diagnose or ‘treat’ someone with schizophrenia. You can however be an ally and listening ear for someone with this illness, so they feel accepted, supported and connected.

Keep an eye out for signs and symptoms – if a person (with or without a diagnosis) is experiencing symptoms that are affecting their thinking, moods or behaviours you may be able to provide a listening ear, keep them safe, and encourage them to connect with someone who can provide formal care. Remaining calm, non-judgemental, positive and physically safe is important if symptoms are active.

Demonstrate acceptance – allowing a person with schizophrenia to talk openly about their illness on their own terms, and showing compassion, interest and acceptance in a genuine way can be a powerful contribution. If you are comfortable doing so, let the person know you are available to have conversations about mental health and their illness on their terms.

Help reduce stigma – choose language that promotes positivity about mental health, help-seeking and acceptance of people with mental illness. Use accurate medical terms and if unsure, ask the person with schizophrenia about what is appropriate to discuss. Avoid language or stories that promote fear, misunderstanding or which belittle people with schizophrenia. Educate yourself and others and don’t be afraid to discuss schizophrenia in a normalising way.

Let the person set boundaries – Understand that a person with mental illness still has a right to autonomy, self-respect and privacy, even when they are displaying challenging symptoms. Don’t ask for information that the person is not comfortable sharing or invade personal space. Do not share details about the person’s mental illness with others unless it is in the act of getting yourself or them support, and even then, seek their consent to share this information. Wherever possible, the person should be involved in making decisions about who to contact.

Know when to act – If a person’s behaviours are becoming severely erratic or disconnected from reality in a way that is a risk to personal safety, or if the person is at risk of self-harm or suicide, you should take steps to keep yourself and that person safe. This may involve connecting with other people that can help, such as escalating the issue in the workplace or at school, or contacting a medical professional.

Ask the person about their Advance Care Directive – an Advance Care Directive is a document (usually not legally binding) that a person with a mental illness may develop with the help of their family or close friends and ideally a medical professional. It is created when the person is well, so that others know the best course of action when they are unwell. It usually includes information about how they wish to be treated (e.g. preferred hospital and treatment team contact details), who needs to be informed if they are unwell (e.g. a family member or friend, someone to take care of their pets) and other important details.

Connect with other services – If you need more information about schizophrenia or you need to encourage a person with possible or diagnosed schizophrenia to access more support, here are some helpful contacts:

• SANE Australia – 1800 18 72 63.
• Health Direct – 1800 022 222

Call 000 if there is an immediate risk to life or safety.