Behavioural Social Work with Schizophrenic Patients in the Community

Abstract

'Community Care' has proved a mixed blessing to schizophrenic patients and their families. For many of these patients it can mean chronic disability with recurrent relapses and an isolated existence without occupation and with severe financial hardship—endured outside instead of inside hospital. For their relatives it can mean chronic worry, hurt, or irritation. This article describes a project which attempted some easement of their situation for one small group of the most severely handicapped and their families. The results suggest that for some, a behavioural approach—the application of learning principles to specific problem behaviours—may be both feasible and helpful. For others, such intervention will be difficult, if not imposs ible, to initiate; and for yet others, it will be inappropriate. A by-product of the project was the strong impression that, even where a Community Psychiatric Nursing Service is in operation, there may be needs that are more appropriately met by a psychiatric social worker.1 There are numerous reports of the successful modification of maladap tive behaviour in inpatient schizophrenics,2-3-4 and there has been a steady proliferation of behavioural programmes in hospitals. Patient-environ ment interaction is viewed in terms of current antecedents and conse quences that may be maintaining problem behaviour. The most common procedures are positive reinforcement and extinction (the withdrawal of reinforcers). The reinforcers involved include social reinforcers, such as