Program of daily activities, exercise and nutrition program and regular sleep.
Deal with concrete, practical issues.
Where paranoia presents, provide emotional support rather than discussing delusional
content (eg "that must be frightening for you ... how do you manage?").
Psychiatric assessment is nearly always indicated if psychotic symptoms are
present. Even if the diagnosis is not schizophrenia, anti-chaotic mediation may
still be helpful in the short-term.
Hospitalisation is indicated if:
a. Symptoms present potential hazard to self, family, community members or other staff (eg
b. Social situation is particularly poor or negative (supported accommodation only may be
c. More intensive observation is required during stabilisation on anti-psychotic drugs
Anti-psychotics reduce psychotic symptoms, reduce the 'emotional push' behind delusional
thoughts and reduce impulsive acts.
They also increase the client's availability to counselling. Adherence to prescribed drugs
is actively sought through a range of motivational and support methods. Monitoring
of side-effects not only reduces discomfort and possible complications, it also improves
The nature of possible interactions with non-prescribed and prescribed substances
should be investigated with medical or pharmacy staff and subsequently discussed with the
Counselling aims to help the client deal with daily issues, support relationship building,
manage anxiety and teach strategies to cope with stress.
Behavioural approaches are useful to identify triggers and reinforcements for bizarre
or disruptive behaviour and managed through stimulus control and alterations to
reinforcement contingencies. Cognitive approaches are generally inappropriate.
Identification of the functional aspects of drug use and developing positive
alternatives as well as dealing with drug use and related problems are all indicated.
While abstinence is generally the option of choice, ultimately, it is the client who
will make the final decision between controlled use or abstinence. Even if the
client chooses abstinence, harm reduction information should be made available in light of
the high incidence of relapse.
Family members may require support as clients in their own right. They may also play
a key role as an extension of the therapy team. Where children are involved, a
careful assessment of child safety is required, generally by someone specifically trained
in this area such as a child protection worker.
After care and rehabilitation
Assertive after-care procedures are normally indicated to monitor the effectiveness of
treatment including medications, as well as to provide ongoing supports to enhance
Rehabilitation services may be required to improve living skills, provide vocational
retraining or integrate into a half-way house..
Support groups exist for those with schizophrenia, drug use problems. Separate support
groups also exist for those with both mental illness and substance use problems.
Support groups also exist for family and friends of those with mental illness and/or drug