Outpatient Treatment Options
Inpatient hospitalization has its uses, but it is not the setting where most care for schizophrenia occurs. Instead, most ongoing care takes place in outpatient settings, often at community mental health centers.
When funding permits and need is acute, schizophrenic patients may benefit from partial or day hospitalization, which are daytime care programs offering medical care, group therapy and many of the milieu therapy benefits previously described. These programs are frequently used as transition steps out of inpatient hospitals. Patients may stay in them for variable periods of time (between weeks and months typically, although lack of funding often cuts stays short).
This is provided outside the hospital setting through community mental health centers and private therapists. Through one-on-one and group care opportunities, therapists are able to monitor patients' health and symptoms, encourage them to keep them on track with appointments, help them to socialize and maintain relationships with other people, to gain assistance with accessing needed resources and in general to help maintain their well-being. This type of therapy focuses on the present not the past or future and is most effective when used as an adjunct therapy along with anti-psychotic medications.
Cognitive Behavioral Psychotherapy (CBT)
CBT is another form of adjunctive psychotherapy available to some schizophrenic patients. CBT therapists teach patients methods for examining their distorted thinking and perceptual processes and reality testing those perceptions with greater accuracy. Using CBT methods, patients are able to minimize their reactions to psychotic symptoms and thus stay more oriented. Because this therapy requires patients to have a certain level of insight into their symptoms, it is most appropriate for medicated patients, and only those medicated patients who are fairly verbal in the first place. CBT is never a first line of treatment for schizophrenia.
Dual Disorders Treatment
Many chronically mentally ill people, including chronic schizophrenic patients, become involved with drugs and alcohol and compound their illnesses with substance addictions. Schizophrenic patients may become involved in these behaviors out of a desire to escape their symptoms, as an attempt to medicate themselves, or out of boredom or peer-pressure (from other addicted patients they may meet). Alcohol and drug use supports rather than lessens psychotic disturbances and further interferes with patients' ability to care for themselves. It also complicates treatment, as addicted patients require both mental health care and substance abuse rehabilitation programs. It is thus often considered a best practice to segregate dually disordered patients (who have both mental illness and substance abuse diagnoses) from simple mental illness patients for treatment purposes.
As with any substance abuse program, the first order of business that a dual disorders treatment program must accomplish is to focus on getting patients to achieve and sustain sobriety. However, unlike a traditional substance abuse program, a dual disorders program must temper sobriety goals with competing goals such as helping patients stay motivated to stay on psychiatric medications, and to maintain an overall therapeutic program. Patients in a dual diagnosis program participate in relapse prevention programs, daily drug testing, psychiatric care and various forms of group psychotherapy. They are also encouraged to participate in various twelve step programs such as Alcoholics Anonymous, Narcotics Anonymous, Marijuana Anonymous or Cocaine Anonymous.