The RANZCP guidelines for Schizophrenia: Why is our practice so far short of our recommendations, and what can we do about it?

Abstract

The new RANZCP guidelines for the treatment of schizophrenia and related disorders highlights what we know works. In this paper, we examine why patients so often fail to benefit from this knowledge and why clinical practice falls so far short of the recommended standard. Instead of the continuous improvement that we expect of health care in general, in psychiatry we face an accelerating decline in systems of care. There has been a sustained underinvestment in public mental health care and a shared failure by State and Federal governments to construct and commit to a governance and funding model that can deliver the standard of care that is available in other major non-communicable diseases, and which we know is equally possible for severe mental illness. This paper sets out some of the reasons for the poor quality of care received by many people with schizophrenia and related disorders in Australia, and describes ways that care could be improved. In particular, we recommend an explicit statement of what constitutes an adequate standard of care, for people at all stages of these illnesses. This would help provide transparency about whether the care provided by mental health services achieves these benchmarks, and enable publication of results comparing the performance of different states and regional services. Patients and families, as well as professional, consumer and carer organizations would then be able to see clearly where the deficits are and demand resources and care that match the recommendations.

Global research priorities for youth mental health

“…With numerous research gaps remaining, adequately responding to youth mental disorders is an ongoing challenge. Even with new innovations and discoveries, translation and implementation have been a pervasive challenge for psychiatry (Insel, 2009;Nielssen, McGorry, Castle, & Galletly, 2017) that can potentially lead to fragmentation and inequality of care. This situation stands even where supporting Cochrane level 1 evidence exists as is the case for early intervention for psychosis (Correll et al, 2018;Fusar-Poli, McGorry, & Kane, 2017; van der Gaag et al, 2013) as well as individual placement and support vocational programs (Modini et al, 2018).…”

“…This situation stands even where supporting Cochrane level 1 evidence exists as is the case for early intervention for psychosis (Correll et al, 2018;Fusar-Poli, McGorry, & Kane, 2017; van der Gaag et al, 2013) as well as individual placement and support vocational programs (Modini et al, 2018). The implementation and routine delivery of evidence-based strategies for early diagnosis and treatment remains poor (McGorry, 2017;McGorry, Ratheesh, & O'Donoghue, 2018;Nielssen et al, 2017) in spite of numerous efforts to reduce the research-to-practice gap, the development of clinical guidelines and the progress of implementation science (Powell et al, 2012;Proctor et al, 2009). Within LMICs, translation is challenging as mental health resources are often limited, inefficiently implemented and unequally distributed (Saxena, Thornicroft, Knapp, & Whiteford, 2007).…”

<p>The Patient-Reported Experience Measure for Improving qUality of care in Mental health (PREMIUM) project in France: study protocol for the development and implementation strategy</p>

“…These mental disorders are often unrecognized or misdiagnosed, leading first to prolonged duration of untreated psychosis and depression5–7 and subsequently to poor outcomes in treatment response, symptoms, and quality of life 8. Under-use of guidelines and inadequate or suboptimal treatments,9 health care variation among geographical regions,10 and poor adherence to treatment by patients remain major challenges for mental health care 11–13. There is thus a need to measure the quality and performance of mental health care in France14,15 as in other Western countries,16,17 in order to propose strategies to improve the quality and efficiency of mental health care 18…”

A structured review of psychiatric rehabilitation for individuals living with severe mental illness within three regions of the Asia‐Pacific: Implications for practice and policy

“…Despite interventions being routinely recommended in clinical practice guidelines, their translation into practice is poor. Many evidenced-based interventions are not accessible and specifically, these interventions do not appear to have been uniformly adopted in the A-P region (Jablensky et al, 2017;Nielssen, McGorry, Castle, & Galletly, 2017).…”