Community-Based Schizophrenia Care

Schizophrenia care falls on a spectrum of intensity. At one end is outpatient care. It is similar to care for any long-term condition. A person manages most things on their own and has regular check-ins with their healthcare team. On the other end of the spectrum is hospitalization. This is an option for people with severe symptoms who are not able to be safe without this level of support.^1,2

There are also care options in between outpatient care and hospitalization. They include residential care, partial hospitalization, and intensive outpatient therapy. But managing schizophrenia often requires many different experts that work outside of those settings. Help with issues at home, work, and/or school are all part of a well-rounded treatment plan.^1,3

This need has led to the creation of several community-based care options that are used alongside traditional healthcare. The most common community treatment options are coordinated specialty care and assertive community treatment.^4,5

Importance of early access to care

The first episode of psychosis is one of the most critical treatment times for people with schizophrenia. Psychosis is when a person loses their connection to reality. They may have delusions or hallucinations, among other symptoms. When a person with schizophrenia has an episode of psychosis, they are considered to be in the active phase of their condition.⁴

Episodes of psychosis may be more severe for some than others. It is possible for a person to be in the active phase of schizophrenia for months or even years before they are treated. This may be related to problems accessing healthcare or the lack of a clear diagnosis.⁴

Researchers have found that the longer a person stays in a period of untreated psychosis, the more likely they are to be hospitalized later. The risk of worse long-term outcomes, including lower quality of life and another episode of psychosis, also increases.^1,4,6

Worse outcomes make living with schizophrenia harder and also increase healthcare costs. Because of this, early treatment before or during their first episode of psychosis is a top priority for mental health experts.^1,4,6

Coordinated specialty care (CSC)

The National Institute of Mental Health (NIMH) has been a leader in improving early access to healthcare. They spent several years collecting data on early intervention versus regular care for people in their first episode of psychosis.^4,6,7

Due to the positive results of earlier treatment, NIMH has started expanding coordinated specialty care (CSC) teams across the county. These teams provide intensive support to those having a first episode of psychosis.^4,6,7

Common services CSC teams can provide include:^4,6

• Individual and group therapy
• Help with medicine management
• Help with employment and education
• Access to a case manager who can provide connections to resources in the area (like food and shelter)
• Support and education for families and caregivers

CSC can be helpful for those with schizophrenia, but it is still growing. CSC teams are not accessible for everyone. For example, they are mostly located in large cities. If you have a loved one experiencing their first episode of psychosis, ask your doctor where the nearest CSC team is to you.^4,6

Assertive Community Treatment (ACT)

Assertive community treatment (ACT) is a similar team-based approach to caring for people with schizophrenia. It also helps people with other long-term mental health conditions that affect daily functioning. An example of these conditions is bipolar disorder.⁵

With ACT, instead of having 1 case manager or 1 social worker to help with social needs, you may have multiple. You also have access to other experts, like pharmacists, occupational therapists, and nurses. Support can be provided at home, in the community, or at healthcare clinics. ACT can be accessed any day and at any time.^5,8

ACT can help people with schizophrenia live more independently and in the setting they would like. Members on your ACT team can help you set and achieve the goals that are important to you. ACT services can assist with:^5,8

• Other healthcare needs
• Substance use issues
• Financial planning
• Work or school performance

ACT also has been shown to reduce:^5,8

• Homelessness
• Unemployment
• Need for hospitalization
• Other potential negative outcomes of long-term schizophrenia

There is typically no limit to how long a person can use ACT. But, like CSC, your ability to access this support depends on where you are located. There are also requirements before admission to an ACT service to determine need, such as having been hospitalized.^5,8

The clubhouse model

Another community-based support option are clubhouses. Clubhouses for those with mental illness are community-based centers designed to provide a supportive and inclusive environment for those living with a mental illness like schizophrenia.⁹

These spaces emphasize empowerment, collaboration, and a sense of belonging. Clubhouses offer a range of activities and programs that help members build life skills, engage in meaningful work, and foster social connections.⁹

For people with schizophrenia, clubhouses can be highly beneficial. They provide a structured routine, a safe space for social interaction, and opportunities to develop vocational skills. People can work toward recovery, regain a sense of control, and integrate more fully into their communities.⁹

Talk to your doctor about treatment options

Both CSC and ACT can be a lot to coordinate. But they can help increase a person’s ability to live independently and improve long-term outcomes. Both CSC and ACT can provide immediate crisis support, too.^4,5,8

Ask your doctor about what community resources exist in your area. Community-based care can help people with schizophrenia and their loved ones maintain a good quality of life.^4,8