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Lauren May Brown, PharmD, BCPP
CPNP Programming Committee Member

It is well known that there is a disproportionately high rate of schizophrenia among homeless persons, with an estimated prevalence of approximately 11% compared with 1% in the general population.1 Schizophrenia and homelessness are associated with significant morbidity and mortality.2 Not surprisingly, homeless persons have a lower life expectancy and are three to four times more likely to die when compared to the population at large.3 Homeless persons with schizophrenia have a worse prognosis and are less likely to receive treatment or utilize mental health services.2,4 There are several barriers to providing care to this population including but not limited to stigma, cognitive dysfunction, imprisonment, and substance use.2

Given the challenges of treating co-occurring schizophrenia and homelessness, there are very few personal accounts of return to a high level of functioning by young persons who suffer a profound psychotic disorder and homelessness. The CPNP Program Committee feels it is important for medical professionals to see a living example in order to appreciate that full recovery from even treatment-resistant schizophrenia is possible.

We are excited to have Bethany Yeiser share her story of living as a homeless person for four years with undiagnosed and untreated mental illness. Before her gradual descent into schizophrenia, Bethany was a promising university honors student. By her third year at the university, she had published three articles in biochemistry and was working as a violinist. Following her junior year of college, she spent three months as a volunteer in the slums of Nairobi, Kenya and Lagos, Nigeria, living in poverty. After her return from Africa, she had her first psychotic break. The insidious emergence of schizophrenia led her on a path away from the university and into a life of delusion and isolation. Eventually, a series of events led her to reclaim her life and make a significant recovery after initiation of clozapine. Bethany was able to finish her bachelor’s degree in molecular biology with honors from the University of Cincinnati.

Today, Bethany is a sought–after motivational speaker with a passion to educate and inspire change in the way schizophrenia is perceived and treated. She has shared her story at numerous conferences and events for physicians and health care providers around the country. Her memoir Mind Estranged: My Journey from Schizophrenia and Homelessness to Recovery is her first book, published in the summer of 2014. Bethany is also president of the CURESZ Foundation, which she established in 2016 with her psychiatrist Dr. Henry Nasrallah.

Bethany Yeiser will present “Patient Perspective: Full Recovery from Schizophrenia and Homelessness,” the Monday opening keynote presentation for CPNP 2020 on April 27, 2020, in Dallas, TX. After this presentation, participants will be able to:

  1. Recognize how a psychotic illness can completely disrupt the lives of both patients and family members, and the need for support, psychosocial and vocational rehabilitation for both patient and family.
  2. Analyze reasons leading to nonadherence in schizophrenia including anosognosia, cognitive deficits, negative symptoms, and substance use.
  3. Deconstruct the pessimistic view and the low expectations of a person diagnosed with schizophrenia.
  4. Examine the benefits of clozapine therapy in patients with treatment-refractory schizophrenia including use early in the disease course.

References

  1. Folsom D, Jeste DV. Schizophrenia in homeless persons: a systematic review of the literature. Acta Psychiatr Scand. 2002; 105(6): 404-413.
  2. Foster A, Gable J, Buckley J. Homelessness in schizophrenia. Psychiatr Clin North Am. 2012; 35(3): 717-734.
  3. Babidge NC, Buhrich N, Butler T. Mortality among homeless people with schizophrenia in Sydney, Australia: a 10-year follow-up. Acta Psychiatrica Scand. 2001; 103(2): 105-110.
  4. Folsom DP, Hawthorne W, Lindamer LG, et al. Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. Am J Psychiatry 2005; 162: 370-376.
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