Schizophrenia, a chronic psychotic condition, has been highly misunderstood and stigmatized, both among medical professionals and in the general public, because of the disruptive and sometimes violent behavior associated with it. Up until recently the drugs that were available to treat schizophrenia had such severe side effects that it was difficult to maintain compliance with a treatment regimen. Recent advances in drug and other treatments, though, have improved patients’ experiences with their therapies and have made it at least theoretically possible for them to return to more normal lives. However, many patients still have not benefited from these advances, for a variety of reasons.

The care of persons with schizophrenia, the prototypical severe mental illness, has been a barometer of mental health care policy in this country for decades. Because this illness is often misunderstood, it has been the focus of reforms driven less by medical knowledge than by the projection of prevailing social attitudes and beliefs. These reforms range from periods of social containment that restricted schizophrenia patients to long-stay mental institutions to periods of social reformation that released most of them to the community in the name of civil rights. Debates in recent decades have raged about whether schizophrenia is even a real illness, not something generated by authoritarian doctors and dysfunctional families who victimize “identified patients.” This has helped to marginalize persons with schizophrenia, their families, and the professionals who seek to help them. This marginalization has been exacerbated by public fears of patients who sometimes exhibit strange symptoms and behavior and who (rarely) commit acts of violence that attract national attention. It is therefore critical to consider the treatment of persons with schizophrenia as it exists today and to explore how the next cycle of reform in their care could and should unfold. The principles of “evidence-based medicine” and managed medical care draw from today’s prevailing empiricism and fiscal pragmatism. Evidence-based medicine reflects a commitment to providing medical treatments supported by scientific data on efficacy as well as the ongoing assessment of outcomes so that treatment can continually improve. Fiscal pragmatism commits us to the rational use of medical re-sources to ensure quality and efficiency

Journal of Health Policy & Management is an open access scholarly periodical that publishes peer-reviewed scientific manuscripts. The journal is intended to enhance communication among health system researchers, policy and decision-makers, legislators, practitioners, educators, administrators, students, and other types of allied health professionals in the research and healthcare delivery systems.

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