Schizophrenia, despite over a 100 years having lapsed since its first description, still remains the scourge of young men and women with over 250,000 sufferers in the UK.

New medications, such as the atypical neuroleptics like Olanzapine and Risperidone, have changed the lives of many sufferers but there is still a long way to go. Sufferers complain of mental pain that is caused by derogatory voices plaguing them all day or delusions that make them believe that they are being persecuted by alien forces from the IRA to the police. These are the positive symptoms of schizophrenia. Many of the older medications like Chlorpromazine and Haloperidol relieved those symptoms but had such horrendous side effects like stiffness, shaking and drooling that in many cases these side effects were worse than the illness itself.

The new medications have opened a gate for sufferers in the last 10 years, by not only relieving the symptoms without the side effects, but also tackling a group of symptoms called the negative symptoms. These were for many years ignored, possibly because they were masked by the more dominant, positive symptoms. The negative symptoms consist of withdrawal, lack of motivation, lack of drive, loss of interest and depression. It was these symptoms that the new atypical drugs began to tackle for the first time.

Unfortunately these newer drugs are more expensive than the old ones and many health authorities began a systematic capping of prescriptions on cost grounds, which led to accusations of postcode prescribing. The NICE Guidance of June 2002 attempted to correct this by recommending that atypical neuroleptic drugs be considered in the choice of first line treatments for individuals with newly diagnosed schizophrenia. The guidance also recommended that for patients currently receiving the older drugs, if the side effects are unacceptable, then atypical neuroleptics should be considered.

Since June 2002, the use of atypical drugs ? as evidenced by sales figures ? has barely altered, which does not fit in to what CHI (the Commission for Health Improvement) has been finding as they look into the clinical effectiveness part of governance. As part of this exercise, the adherence to evidence based reports like NICE, should be examined. It would seem that many Trusts are claiming to adhere to NICE but in reality this is not borne out by evidence. One vital part of the CHI visit involves the interviewing of patients by patient CHI members. These team members are every bit as thorough as the rest of the team but have to rely on in-patients volunteering to come forward and be interviewed for a small fee. The problem is that those patients who are so tortured by their positive and/or negative symptoms, will never be able to volunteer and would not even be fit to be interviewed if they did. We are therefore only detecting the tip of the iceberg, those who have only minor illnesses and as usual, the sickest ones lose out. Who will speak for them? At present the answer is no-one.

One solution is for a monitored ward round to be undertaken with an independent psychiatrist who can check on the wellbeing of all the patients at random. This could be part of CHI or the new CHAI (Commission for Audit and Inspection) or a separate exercise. Some may argue that such an exercise would be an unnecessary incursion into the privacy of sufferers and their relationship with the multidisciplinary team. However, we already have mental health review tribunals for detained patients and random visits by mental health commissioners that are patient focussed. These appear to be tolerated by all sides as beneficial to the general welfare of patients.

Maybe, if we can have respected senior professionals with expertise in schizophrenia care ? approved by the carers' charities and the mental health Tsar ? then we can get to the root of the problem and enable all sufferers to benefit from the latest developments. With increased evidence that schizophrenia is worsened and sometimes precipitated by illicit drugs like cannabis, cocaine and amphetamines, we cannot afford to delay in spreading best practice.