Published December 20, 2022
Clinicians should approach their psychiatric care of adults with schizophrenia with a degree of cultural and intellectual humility, recognizing patients are the experts on their lived experience. It’s not feasible nor necessary for clinicians to become experts on each patient’s race, religion, culture, or beliefs. However, by practicing humility and curiosity, we can learn from patients’ experiences and continue to refine our clinical practice. In this way, we become better clinicians through our relationships with patients, deepening our understanding of their views and feelings on mental health and wellness and, in turn, improving the care we provide them.
Furthermore, the mental healthcare provider shortage is such that patients do not always have the luxury of finding a provider with shared beliefs, values, or aspects of identity. As such, we must help adults living with schizophrenia engage in self-advocacy and self-care to find ways to meet their needs beyond the clinical care encounter. Sometimes patients or families are searching for a “silver bullet,” but holistic recovery from schizophrenia often requires more than only medical treatment.
For example, adults with schizophrenia and their families must advocate to create meaningful employment opportunities and find a sense of community. These are critical components of the recovery journey, as people heal through not only medication but also through social connections and finding purpose in their experience. Unfortunately, adults living with schizophrenia are often met with marginalization and discrimination, further isolating them and making an already challenging experience even more difficult.
Nevertheless, clinicians can sometimes facilitate a therapeutic relationship by identifying similarities and shared experiences. For example, I often draw from my Hispanic culture and background when seeing Hispanic patients. I can connect through shared identities and values, such as being the children of immigrants or being first-generation Americans, and the work ethic, sense of opportunity, and ambition this instills. There may also be cultural references to certain Latin foods or music or humor that, when exchanged, can help us build rapport.
My dual identity as an adult living with schizophrenia and a psychiatric mental health nurse practitioner (PMHNP) also allows me to break down the hierarchy that may exist between patients and myself. Open communication with patients leads to better care—allowing a clinician to know the things that matter most to their patients and meet their needs. And for me, that may mean sometimes deciding to self-disclose my lived experience to establish trust and strengthen the therapeutic alliance.
Recognizing the Expertise Provided by Adult Patients
Patients are the experts on their lived experience, and recognizing this expertise is crucial to providing collaborative and supportive care. Clinicians often view schizophrenia in terms of clinical descriptors—hallucinations or delusions, disorganized thinking, and inability to concentrate or focus. Adults living with schizophrenia often describe the condition in human or functional terms—like trying to reduce the number of bad days, not feeling so overwhelmed, or having a desire to get better grades in school or live independently.
Treatment team members need to understand that our clinical descriptors, while important, may be insufficient for understanding the patient’s needs or goals. We should reframe management and care in terms of the outcomes or developmental milestones they wish to achieve. A way to think about our job is bridging the unmet need and the patient’s goals through our clinical care, for example, advising our patient this treatment plan may help them sleep better so they can get back to focusing on school.
To do this, I approach my clinical encounters with adult patients with a strengths-oriented framework, aiming to treat the whole person and not simply assess the patient’s disease or focus on deficits. Together, the patient and I identify goals and aspirations, highlighting what they can achieve by focusing on how we can move forward and recognizing the potential in the patient beyond the diagnosis.
Emphasizing Education and Empowerment
When I started working in mental health, the common assumption was that long-acting injectable (LAI) antipsychotics were for adults who had been in the mental health system for a long time, having failed multiple treatment modalities. However, evidence suggests this might not be the case, as recent guidelines and guidance have expanded the use of LAIs in appropriate patients.
As such, education on LAIs is a crucial component of schizophrenia management and care. Clinicians and adults with lived experience need the education to overcome the stigma or misperceptions frequently associated with LAI interventions. It’s essential to listen to adult patients, letting them ask questions about treatment options and working to answer and address those questions. I often draw parallels to other medical fields when discussing LAIs and find patients curious about administration, treatment duration, and how they might differ from oral medication. When seeing patients and determining who may be a good candidate for or benefit from an LAI, it is important to consider patient preference, caregiver preference, challenges with adherence, and whether it is viable for a patient to come into the office once a month or more often.
As a clinician, our practice setting sometimes dictates our prescribing habits. For example, as a PMHNP, nursing education has no residency infrastructure, so you often develop your practice preferences and norms on the job. If your first few jobs use LAIs, you will learn how to use them, but if they don’t, you will likely be less familiar with the formulations, administration, payment instructions, or fulfillment processes. Opportunities for continued education on all viable treatment options are crucial, especially for nurses, given the different training and education modalities. For clinicians like PMHNPs, and adults with lived experience, it often boils down to education to demystify treatment options, like LAIs, to empower the shared decision-making between patient and provider.
For adults with lived experience, medication adherence could increase the odds of managing symptoms and achieving success on the recovery journey. However, many adults living with schizophrenia, including myself, reach a period of temporary stability and stop taking their medication as prescribed. It sometimes takes a near-second episode to finally register that this illness is a lifelong condition requiring ongoing care. This makes it even more critical for adults with schizophrenia to understand that medication adherence is necessary to stay well.
I became a clinician not only to make sense of my experience and understand what I would need to do to cope with my illness but also to pay it forward and help others going through similar journeys. Schizophrenia is a chronic condition, and while we cannot yet prevent it from developing, we can mitigate its impact with early intervention and sustained treatment. This illness requires lifelong management, but helping patients achieve their goals is possible with knowledge, empowerment, and the right support system.
This article reflects my own experience and opinions and was developed in joint collaboration by Janssen Pharmaceuticals, Inc., and myself. I have been paid an honorarium for my time.
As a psychiatric mental health nurse practitioner (PMHNP), I’m challenged to continually learn—evolving my approach to nursing care and growing my knowledge base to ensure I am meeting the needs…