title: Responding to challenges for people with psychotic illness: Updated evidence from the Survey of High Impact Psychosis.
abstract: OBJECTIVE
  The objective is to summarise recent findings from the 2010 Australian Survey of High Impact Psychosis (SHIP) and examine their implications for future policy and planning to improve mental health, physical health and other circumstances of people with a psychotic disorder.
  
  
  METHODS
  Survey of High Impact Psychosis collected nationally representative data on 1825 people with psychotic illness. Over 60 papers have been published covering key challenges reported by participants: financial problems, loneliness and social isolation, unemployment, poor physical health, uncontrolled symptoms of mental illness, and lack of stable, suitable housing. Findings are summarised under the rubric of participant-ranked top challenges.
  
  
  RESULTS
  The main income source for the majority (85%) of participants was a government benefit. Only one-third was employed, and the most appropriate employment services for this group were under-utilised. High rates of loneliness and social isolation impacted mental and physical health. The rate of cardiometabolic disease was well above the general population rate, and associated risk factors were present from a very young age. Childhood abuse (30.6%), adult violent victimisation (16.4%) and alcohol and substance abuse/dependence (lifetime rates of 50.5% and 54.5%, respectively) complicated the clinical profile. Treatment with medication was suboptimal, with physical health conditions undertreated, a high rate of psychotropic polypharmacy and underutilisation of clozapine in chronic persistent psychotic illness. Only 38.6% received evidence-based psychosocial therapies. In the previous year, 27.4% had changed housing and 12.8% had been homeless, on average for 155 days.
  
  
  CONCLUSIONS
  Money, social engagement and employment are the most important challenges for people with psychotic illness, as well as good physical and mental health. An integrated approach to recovery is needed to optimise service delivery and augment evidence-based clinical practice with measures to improve physical health and social circumstances. Meeting these challenges has the potential to reduce costs to government and society, as well as promote recovery.
authors.affiliation: 1 Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.|2 Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.
authors.forename: Vera A
authors.initials: VA
authors.lastname: Morgan
authors.affiliation: 1 Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.
authors.forename: Anna
authors.initials: A
authors.lastname: Waterreus
authors.affiliation: 3 Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.|4 Schizophrenia Research Institute and Neuroscience Research Australia, Sydney, NSW, Australia.|5 Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.
authors.forename: Vaughan
authors.initials: V
authors.lastname: Carr
authors.affiliation: 6 St Vincent's Hospital, Melbourne, VIC, Australia.|7 Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Castle
authors.affiliation: 8 Hunter New England Mental Health, Newcastle, NSW, Australia.|9 The University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Cohen
authors.affiliation: 7 Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Harvey
authors.affiliation: 10 Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.|11 Ramsay Health Care, Mental Health Services, Adelaide, SA, Australia.|12 Northern Adelaide Local Health Network, Adelaide, SA, Australia.
authors.forename: Cherrie
authors.initials: C
authors.lastname: Galletly
authors.affiliation: 13 Black Dog Institute and University of New South Wales, Sydney, NSW Australia.|14 Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mackinnon
authors.affiliation: 15 Orygen Youth Health Research Centre, Melbourne, VIC, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: McGorry
authors.affiliation: 16 Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia.|17 Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.
authors.forename: John J
authors.initials: JJ
authors.lastname: McGrath
authors.affiliation: 18 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Neil
authors.affiliation: 19 Health Data Analysis Pty Ltd, Canberra, ACT, Australia.
authors.forename: Suzy
authors.initials: S
authors.lastname: Saw
authors.affiliation: 2 Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.|20 Cooperative Research Centre-Mental Health, Carlton, VIC, Australia.
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Badcock
authors.affiliation: 21 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Foley
authors.affiliation: 17 Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.
authors.forename: Geoff
authors.initials: G
authors.lastname: Waghorn
authors.affiliation: 22 SANE Australia, Melbourne, VIC, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Coker
authors.affiliation: 2 Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.|20 Cooperative Research Centre-Mental Health, Carlton, VIC, Australia.
authors.forename: Assen
authors.initials: A
authors.lastname: Jablensky
mesh_terms: D001315:Australia / Q000453:epidemiology; D019548:Crime Victims / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data*; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D011618:Psychotic Disorders / Q000453:epidemiology*; D012934:Social Isolation
keywords: Employment; physical health; schizophrenia; social isolation; victimisation