Schizophrenia Care Among People Experiencing Homelessness in the Matanuska Susitna Borough

Abstract

Schizophrenia is a chronic mental disorder that often manifests in early adulthood (Jauhar et al., 2022). Positive symptoms include reality distortions, disordered thinking, hallucinations, or delusions; while negative symptoms are seen in an individual’s lack of motivation and expression (Jauhar et al., 2022; Norris, 2019). Cognitive deficits are also a clinical feature (Harvey et al., 2022; Jauhar et al., 2022). Schizophrenia affects an estimated 0.3 – 1.6% of the United States population (Finnerty et al., 2024). Most recent data from Alaska reveals 1,664 Alaskans live with schizophrenia (Heun-Johnson et al., 2019). Despite the small percentage of the population with a diagnosis, these individuals have a disproportionately high burden of disease. Patients with schizophrenia are hospitalized at a higher rate than those with other severe mental health disorders and their stay is longer and more costly (Heun-Johnson et al., 2019). The burden of the disease is also felt as a loss of productivity, as patients may be unable to maintain employment, need significant support from caregivers, and have shorter lives (Heun-Johnson et al., 2019; Schizophrenia & Psychosis Action Alliance, 2021). Many people with schizophrenia live independently, but others are unhoused, live in care facilities, or are incarcerated, which adds to disease burden (Schizophrenia & Psychosis Action Alliance, 2021). The current standard of care for schizophrenia involves pharmacologic and nonpharmacologic approaches. Antipsychotic medications are the cornerstone, although common side effects complicate adherence to treatment, including obesity, metabolic disturbances, or tardive dyskinesia (Rubio & Kane, 2022). Pharmacologic treatment reduces the symptoms of schizophrenia, and accompanying non-pharmacologic interventions can improve quality of life (McDonaugh et al., 2017). Early detection and treatment lead to a better long-term prognosis (Crawford & Go, 2022, Lin & Lane, 2019). The National Institute of Mental Health (NIMH) gathered approaches to managing schizophrenia into a package called coordinated specialty care (CSC) (NIMH, 2023). CSC is based on early intervention and an individualized treatment plan that provides medication management, cognitive behavioral therapy, family support, case management, employment support, and psychoeducation (NIMH, 2023). This approach is also reflected in the most recent practice guideline from the American Psychiatric Association. This guideline includes recommendations related to initial assessment, the use of antipsychotic medication, CSC programs, cognitive behavioral therapy, assertive community treatment for patients with histories of poor adherence or relapse, as well as employment, social skills, family, and cognitive support (Keepers et al., 2021).