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Schizophrenia and NICE: all quiet on the community front?
  1. Mark Salter
  1. Correspondence to Dr Mark Salter, Adult General and Community Psychiatrist, East London Foundation NHS Trust, City and Hackney Centre for Mental Health, London E9 65R, UK; mark.salter{at}

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“No battle plan survives contact with the enemy” attributed to Sun Tzu

Although the concept of psychotic illness was known to the healers of his age, Sun Tzu did not have mental illness in mind when he penned those words two and a half thousand years ago. His maxim nonetheless remains true of both our responses to war and to schizophrenia. They have much in common. Both are universally associated with images of horror and darkness. Both carry an awful cost—1% of the human population will suffer a psychotic breakdown, often in young adulthood. Both are ever changing. War has altered beyond recognition since 1911 when Bleuler first coined the term “schizophrenia” to describe a shattering of the mind. When the Captains of American psychiatry met last year to consider their future nomenclatures, they came close to dropping the S word altogether. Over here, our top brass—their chateaus as far from the front line as ever—are talking instead of “salience disorder”.

Many psychiatrists, accustomed to the realities of care for people with psychotic illness in a world of broken families and broken windows, will at once be struck by the discrepancy between the order and optimism enshrined in the recently revised National Institute for Health and Clinical Excellence (NICE) guidelines for schizophrenia1 and the stark reality of the world seen in …

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