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How today’s pandemic and changes in the delivery of mental health care is impacting many individuals. While we are seeing the positive outcomes of telehealth in various mental health diagnoses, like depression and anxiety, it made me take a step back to think about how this may not be working for individuals with other mental health illnesses like schizophrenia and psychosis. When thinking back to my first job working in outpatient adult mental health, I worked with a few clients who had paranoid schizophrenia and there would be no way that they would engage in a telehealth mode of mental health services as they believed the police were monitoring them through phones/computers/televisions. Research that has been conducted looking at the effects of telehealth medicine in schizophrenia patients have found that specific apps on smartphones are helpful in this population for reminders to take medications daily, but are not particularly beneficial with the negative symptoms associated with schizophrenia (Krzystanek, Krzeszowski, Jagoda, & Krysta, 2015). Your client appears to be responding well to medication as evidenced by a decreased in positive symptoms however, it appears that what needs to be closely addressed are his negative symptoms, including a lack of motivation for areas in his life. Like you had mentioned, due to a non-compliance to engage in therapy, unfortunately, the liklihood that he will return back to your facility within the next couple of months is high which only perpetuates the cycle.

     While your facility may limited in the types of resources and support networks that are available, I think that a closer look needs to be made on how to specifically address the low motivation. What type of activities or things are meaningful to this patient? While the psychoanalytic approach is the therapeutic modality that is utilized, I think that perhaps looking beyond this from a psychosocial and holistic perspective may be beneficial. For example, research studies are starting to see a correlation between negative symptom improvement with a look at the patient’s diet by incorporating more Vitamin D and folic acid supplements (Ganguly, Soliman, & Moustafa, 2018). At the end of the day, the main topic that truly needs to be addressed in this client is his quality of life – specifically, what can be done to improve his quality of life to lead a life worth living so he is not simply going back to sleep after taking his medications. Another option, though may be difficult to get the client to engage in, is to recommend yoga therapy. In individuals with schizophrenia, yoga therapy has been proven to be highly beneficial in the reduction of both positive and negative symptoms as oxytocin is produced contributing to an increased feeling of well-being (Ganguly et al., 2018). 

                                                                                                References

Ganguly, P., Soliman, A., & Moustafa, A. (2018). Holistic management of schizophrenia symptoms using pharmacological 
     and non-pharmacological treatment. Frontiers in Public Health, 6(166), 1-9. doi:10.3389/fpubh.2018.00166
Krzystanek, M., Krzeszowski, D., Jagoda, K., & Krysta, K. (2015). Long term telemedicine study of compliance in paranoid
     schizophrenia. Psychiatria Danubina, 27(1), 266-268. Retrieved from https://www.psychiatria-danubina.com/UserDocs
     Images/pdf/dnb_vol27_sup1_266.pd