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Schizophrenia

This fact sheet is designed to help MBF members and their families be better prepared for their healthcare experience after a diagnosis of schizophrenia.

Not all of the information here will be applicable to everyone, so it is important to discuss your individual circumstances with your doctor and other healthcare professionals caring for you. Please, never hesitate to ask 'why' or to have something explained to you until you understand it. If, after you have been given an answer, you still feel as though there are unanswered questions, ask again or ask someone else. You can help the healthcare team to help you if you feel free to communicate your needs to them. Further research and reading (see 'Learn more about schizophrenia and its management and treatment') will also help you make more informed decisions about your treatment.

About schizophrenia  

Schizophrenia is an illness that is widely misunderstood, yet it affects around one in every 100 Australians. In recent years, growing awareness about the prevalence of mental illness in our society has led to a significant improvement in, and understanding of, this condition and the best treatment methods. There has also been an increase in the number of reliable and helpful support and information agencies available to help people with schizophrenia and their families. Despite this, there is still much that's unknown about schizophrenia and its treatment, and much for society to learn about how best to support people with schizophrenia, their families, friends and carers.

If you or someone close to you has been diagnosed with schizophrenia, then it is important to understand that it is usually a condition that requires ongoing treatment and management. Often, you may find that symptoms do not seem to be present or are reduced and then come back (relapse). However, continuing with treatment is vital to help keep the symptoms to a minimum.

The symptoms of schizophrenia are often isolating for the person concerned, including a feeling of confusion or a fear of even familiar people, places and activities due to delusions or auditory hallucinations. This means that many people with schizophrenia need extra help with everyday activities, including work and having a social life. Recognising this and trying to get good help and support, with the involvement of family, friends and if possible work or school environments, offers the best chance for people who have schizophrenia to minimise its disruption to their lives.

A recurrence of psychotic episodes, even despite taking medication, may mean the need for increased or changed medication or more intensive treatment, including in hospital or a community support facility. In severe cases, there may be a real danger of self-harm or harm to others. So it is particularly important to learn to understand and monitor your own (or your friend's or relative's) condition, so you can take effective steps for treatment and management.

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Treatment and management options  

In general, the earlier treatment is received, the better. It will almost invariably involve some kind of anti-psychotic medication, along with specialist psychiatric monitoring, community support and a partnering approach from family and friends.

Depending on where and how the diagnosis is made, your first port of call may be your GP, a counsellor, or, if there has been a more sudden onset, a mental health crisis team attached to a major hospital or an emergency department. Either way, a referral to a psychiatrist to help confirm the initial diagnosis and help develop a treatment plan is the next step.

Depending on the individual case, the psychiatrist will often take over ongoing care. The GP still has an important role as the person best able to coordinate all the aspects of care you might need and many GPs have undertaken additional training to help meet the needs of people with schizophrenia and may continue to play a major role in your management.

The type of treatment that is likely will depend on, among other things:

  • the severity of the condition;
  • the age and general health of the person concerned - he or she may have other conditions that affect treatment decisions;
  • how long he or she has had schizophrenia; and
  • what, if any, other treatments have been tried.

If you have just been diagnosed, your doctor may suggest one or more of the following to you:

  • psychological therapy from a mental health professional can, in conjunction with other treatments, be helpful;
  • community support options, especially to help with needs such as accommodation and employment, and self help groups;
  • hospitalisation may be required from time to time, where there has been a severe psychotic episode or there is a concern about the person's ability to care for him or herself properly; and/or
  • medication, usually prescribed by a psychiatrist, may be one of a range of drugs (known as anti-psychotics), which can help restore a chemical imbalance in the brain and reduce symptoms like delusions, paranoia and hallucinations.

Again, active involvement from friends, family and community support organisations offers the best chance of helping to gain independence and lead as normal a life as possible, outside the hospital setting.

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Tips on taking medication  

Anti-psychotics are powerful drugs that, in general can be divided into two types, an older group that might be called the "typical" medications; and a newer group known as "atypical". These newer drugs generally have fewer side effects than the older medications. No anti-psychotic drug is a "cure" for schizophrenia. They can however reduce symptoms and help with calmer, clearer thinking and better quality of life.

Because there are many available anti-psychotic medications sometimes it may take some time to find the right type of drug and dosage. It is also very important to understand and remember some basic principles regarding anti-psychotic medications:

  • The medication may need to be taken for some time (up to six weeks) before any improvement is noticed.
  • It may cause side effects, especially the "typical" medications, which may include stiffness of the face and limbs, restless leg movements and trembling. In some cases, your doctor may want to monitor liver function, red blood count or other functions via a blood test when certain new medications are started, to check for side effects. If side effects from medication are suspected or symptoms you feel might be caused by taking the medication, your doctor should be contacted immediately. You might want to ask a family member or friend to accompany you if you are concerned that there were problems with the medications. Some side-effects can be managed, while others warrant a change of drug, but this should always be done in partnership with your doctor.
  • You may also have to be careful about mixing the medication/s you are on with other medications and especially alcohol. Avoiding misuse of alcohol and other drugs is also important.
  • It is extremely important to continue taking medications as prescribed by your health care providers, even if you are feeling well. If you do stop taking them, you are likely to experience symptoms again. It is a common cause of relapsing when people stop their medication as soon as they feel a little better and then their symptoms come back gradually and often without their realising. Suddenly stopping the medication without consulting with your doctor may also result in serious withdrawal effects. Taking medication regularly and according to instructions is vital, and special attention needs to be paid to this during episodes of psychosis.
  • Your medication should be reviewed regularly by your psychiatrist or treating doctor to make sure it is still the most appropriate choice for you.

As outlined previously, the best results usually occur with ongoing treatment, even when symptoms are reduced. See 'Questions to ask your doctor' to help you prepare for conversations with your doctors regarding your medications.

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Questions to ask your doctor  

Decisions about the treatment and management of schizophrenia will depend very much on the individual case. It can be very helpful for a friend or family member to attend a doctor's appointment so everyone can be very clear about what the issues are and the best plan for treatment.

To the GP/referring Doctor:

  • Why have you chosen to refer me to this psychiatrist or psychologist?
  • Could you please explain to me what medication you have recommended and why? Would you mind explaining this to my family & friends so that they can assist me if I need help?

To the specialist doctor:

  • Can you explain what schizophrenia is and your reasons for this diagnosis?
  • Are you certain about the diagnosis, or may it change over time?
  • Will you or my GP be handling my ongoing care?
  • Can you explain, in simple terms, what you think is the best treatment option in this case and why?
  • What are the likely outcomes of my treatment?
  • What can I expect in the long term?
  • What other treatment options are there and how effective are they?
  • What are the chances that the outcomes will be good, with this treatment or with the alternative options?
  • Are you associated with a mental health team? Are there others that would be part of my care team?
  • What, if any, changes in my lifestyle (exercise more, better nutrition) could I adopt to help me better manage my schizophrenia?
  • How can my family & friends help?

Questions about medication

Always share a list of the drugs you are currently taking with your health care provider, including your pharmacist, when discussing your medication options and discussing this list of questions. Write a complete list of all the current drugs you are taking, including the name of the drug and the dosage (typically stated in mg). Remember to include those drugs prescribed by doctors and drugs and supplements you buy over-the-counter without a doctor's prescription, even if you take them occasionally.

  • What are my medication options?
  • Why are you prescribing this particular medication? How does it compare with other available types?
  • What impact should the medication have on my symptoms?
  • What are the side-effects of the various options? Is there anything in particular I should be considering when we are choosing the right medication and its possible side-effects compared to some of the others.
  • Can you think of any ways I would be more likely to recognise if my symptoms are returning/getting worse?

If your doctor recommends hospitalisation (see also What MBF pays toward my treatment)

  • Do you know how long the hospital stay is likely to be? Under what conditions will discharge occur?
  • What sort of monitoring and follow-up treatment should I expect once my initial treatment is over?
  • Is there a community care organisation that could help me and/or my family with ongoing support? Or other groups that may be able to help?

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Living with schizophrenia  

If you, or a friend or family member, have schizophrenia, it's especially important for everyone concerned to be very aware of the signs and symptoms of a psychotic episode or worsening of the condition and, in some cases, triggering factors (such as lack of sleep or alcohol or other drug use). It may sometimes be possible to avoid or reduce the impact of these factors in your life. Trying to have some healthy routines, such as exercise and regular sleep can, in many cases, offer structure and foundation that can help with independent living.

Similarly, your doctor may be greatly helped by a close friend or family member providing insights into your general wellbeing. This can help everyone concerned gain a better understanding of how severe the condition is, how well the treatment is working and how best to manage it over time.

What MBF pays toward treatment 

Understanding how the healthcare system works can be confusing. Most of your treatment will not be in a hospital setting as an inpatient, so it is likely your medical bills will be reimbursed in part by Medicare, and some non-medical services you receive may be from a public health service provider. However if you require admission to hospital, always check with MBF before you go. This brief summary outlines what MBF pays toward mental health treatment.

Your hospital costs  

All levels of MBF hospital cover help pay for in-patient treatments for schizophrenia provided that:

  • they are provided to you while you are formally admitted to a hospital;
  • they are treatments for which Medicare pays a benefit;
  • they are not an Excluded Service on your level of cover; and
  • you've met all the standard conditions of your membership (like serving the relevant waiting periods).

Your MBF hospital cover will help pay for the following treatments and services so long as you are formally admitted to the hospital and the above conditions are met:

  • shared accommodation (or private room if available),
  • drugs supplied as part of your inpatient hospital treatment, and
  • rehabilitation and other therapies such as psychology, occupational therapy, dietetics, and social work as part of your inpatient hospital treatment.

The cost of participating in clinical trials and experimental drugs are not covered by private health insurance.

Remember, if you are not in an MBF Network Hospital and/or public hospital, you may incur substantial out-of-pocket expenses for your hospital charges.

Please note that doctors' charges will be part of your medical costs.

Your medical (doctors') costs 

If your doctor thinks you may need to go to hospital for care, ask your doctor to explain the costs of your inpatient care including their own fees, any fees that other doctors might charge, and any other expenses involved. Remember, there may be more than one doctor involved in your care. You may not meet them all in person.

Each doctor will charge separately for his or her services and may or may not charge a gap.

Key things for you to know about medical costs and your health cover are:

  • MBF will pay benefits toward your doctors' charges for the service you receive:
    • when formally admitted as an in-patient in hospital or day surgery, and
    • when the service relates to treatment included under your level of cover, and
    • when you are entitled to a Medicare benefit for the treatment.
  • The Medicare Benefits Schedule Fee ('MBS') is the amount determined by the Commonwealth Government for the purpose of paying Medicare Benefits. For eligible in-patient services, Medicare pays for 75% of the MBS; MBF pays the remaining 25%.
  • Many doctors charge above the MBS, creating a 'gap' - an amount the patient has to pay.
  • MBF does not pay any amount charged by your doctor above the MBS unless there is an agreement in place between your doctor and MBF. This agreement is known as the MBF Medical Gap Cover Scheme.
  • MBF has created the MBF Medical Gap Cover Scheme to help reduce gaps paid by members. Doctors who participate in this scheme have agreed to accept the MBF benefit as full payment for your treatment. If a doctor has agreed to treat you under the MBF Medical Gap Cover Scheme there will be no 'gap' to pay for that doctor's charge.
  • It may be that not all doctors involved in your hospital treatment are 'no gap' doctors. So you may have to pay a gap for some doctors' services, but not others.

Remember, doctors are independent of MBF and can decide whether or not to treat you under the MBF Medical Gap Cover Scheme.

Click here for a list of 'no gap' doctors or call MBF.

Other costs relating to your treatment and recovery  

If you have MBF extras cover, MBF may also help with the cost of a number of other healthcare providers or community-based services that may assist with the treatment and management of schizophrenia. These are not payable during a hospital admission.

Depending on your level of MBF extras cover these benefits may include:

  • occupational therapy, to help you re-establish your usual living or working routine;
  • psychology, such as Cognitive Behavioural Therapy (CBT), group therapy, and counselling for you and family members included on your cover;
  • pharmacy (for drugs not listed on the Pharmaceutical Benefits Scheme);
  • dietetics provided by a Registered Dietitian to help establish good eating habits;
  • Living Well Programs to help pay for things like gym membership fees or yoga classes (restrictions apply); and
  • complementary therapies such as remedial massage.

MBF extras benefits are only payable for services provided in Australia by an MBF Recognised Provider. MBF Recognised Providers are health service providers that meet MBF guidelines. Call 131 137 to confirm whether or not your provider is a MBF Recognised Provider.

You can enjoy higher benefits on all preventive and general dental services and selected physiotherapy, optical, pharmacy and gym membership services (restrictions on claiming apply) by using the growing MBF MemberCare network of service providers. With our MBF MemberCare network of providers, you are guaranteed of receiving at least 70%-90% of the charge back on selected services depending on your level of cover, up to the annual limit of your cover. Find an MBF MemberCare service provider.

More about schizophrenia and its treatment 

More about going to hospital, MBF Network hospitals, no-gap doctors, and MBF MemberCare providers 

As well as calling MBF, you can find plenty of useful information about your health cover and what to expect when you go to hospital right here on this website.

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Last updated: 05-06-07

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