Supporting People with Schizophrenia: A Guide for NDIS Support Workers
This guide brings together current research and the practical experience we have gained supporting people with psychosocial disability across South East Queensland. Our hope is that by sharing what we have learned, more individuals, families and support workers can benefit from support that is respectful, person-centred and evidence-informed.
Registered NDIS Provider · Gold Coast, Logan, Ipswich & Brisbane
Schizophrenia is a complex, chronic and deeply individual experience. Effective support is not about managing someone from a safe distance. It is about building genuine trust, reducing unnecessary barriers, and creating consistent conditions in which a person can pursue a life that is meaningful to them.
At Hearts In Action, these principles guide the way we support people every day. This guide combines evidence from the research with practical insights from our work alongside people with psychosocial disability and their families. We hope it encourages thoughtful, compassionate support that helps people build stability, pursue their goals and live life with dignity and choice.
A note before you read on
Every person is unique, including every person with schizophrenia. This guide brings together common patterns identified through research, but these patterns will look different for each individual. There is no single experience of schizophrenia and no approach that will suit everyone.
Use this guide as a way to build understanding while remaining open, curious and responsive to the person you are supporting. Their experiences, preferences, strengths and communication should always guide the support they receive.
The Relationship Is the Intervention
If there is one finding that cuts across every major study in this field, it is this: the quality of the relationship between a support worker and the person they support is the single most powerful predictor of positive outcomes. A 2021 study in Community Mental Health Journal found that eighteen of twenty participants directly attributed improvements in their lives to the relationship with their case manager (Roebuck et al., 2021), with one participant saying: "Before her I wouldn't go to groups. Before her, I was too afraid to get help." A 2025 multi-site study of 282 patients with schizophrenia spectrum disorder found they valued the therapeutic relationship even more than staff themselves realised, and that higher staff burnout was directly associated with a weaker working alliance (Zarbo et al., 2024). The relationship between your own wellbeing and the quality of support you provide is not incidental. It is measurable.
It's worth remembering
Be someone they can rely on. Keep your word, arrive when you say you will, and be honest if plans change. For many people with schizophrenia, a support worker who is genuinely reliable is not a small thing. It is the foundation everything else is built on.
Embrace Person-Centred, Autonomy-First Thinking
Research consistently shows that people with schizophrenia want to be active participants in their own care, not passive recipients of decisions made by others. A 2022 study found that four-fifths of people with psychotic disorders felt participation in decision-making was both desirable and achievable, even during periods of more severe illness, yet two-thirds reported professionals made decisions for them without genuine involvement (Haugom et al., 2022). More than 70% of people with schizophrenia in outpatient settings have adequate decision-making capacity for their own treatment choices, even with active symptoms (Lepping et al., 2020), and autonomy-supporting approaches are among the strongest protective factors for long-term wellbeing (Hormazábal-Salgado et al., 2024). This is the same principle we build into community access support at Hearts In Action: the person's goals shape the plan, not the other way around.
It's worth remembering
Let the person's priorities shape the session. Ask rather than tell, and offer real choices at every opportunity, including small ones. Genuine choice rebuilds the sense of agency that paternalistic care can quietly erode.
Know What You Are Actually Supporting
Schizophrenia affects approximately 1% of the global population and is the third leading cause of disability worldwide (Solmi et al., 2023). Its symptoms fall into three categories that need very different support responses. Positive symptoms, those added to a person's experience, include hallucinations, delusions and disorganised speech, and are real to the person living them. Medication reduces them for most people but not everyone (Anwar et al., 2025). Negative symptoms, a reduction in normal function such as blunted emotion, low motivation and social withdrawal, have the greatest impact on daily functioning and are the least effectively treated by medication, so are often mistaken for laziness rather than recognised as clinical features (Barlati et al., 2024). Cognitive symptoms, including difficulties with memory, attention and planning, are more predictive of a person's ability to live independently than positive symptoms, and require practical adaptations in how you communicate and structure support (Anwar et al., 2025).
It's worth remembering
Negative symptoms are not a character flaw, and they are not directed at you. If someone struggles to initiate an activity or seems hard to reach, that's a symptom, not a rejection. Stay consistent. Gentle, reliable engagement works far better than pushing for enthusiasm the person cannot produce right now.
Communication: Be Clear, Be Direct, Be Present
Indirect language, softened requests, or too much information at once creates confusion and distress for people managing cognitive symptoms of schizophrenia. Clear, direct, single-step communication produces dramatically better understanding and significantly less anxiety (Anwar et al., 2025). People who feel genuinely listened to describe this as the gateway to trust. Feeling dismissed or pathologised leads directly to concealing symptoms and disengaging from care (Martí-García et al., 2025). When someone is experiencing active symptoms, don't argue with delusions or try to disprove hallucinations: acknowledge the emotional experience underneath instead. "That sounds really frightening. What would help you feel safer right now?" works better than debating what is or isn't real.
It's worth remembering
Say what you mean and mean what you say. Speak simply, directly and calmly. Allow processing time: cognitive slowing means a person may need longer to respond, and that pause deserves patience, not prompting.
Structure Is Therapeutic
A 2024 study of people with schizophrenia and severely impaired social functioning found participants had very few structuring elements in their days and experienced time as shapeless and difficult to fill (Ben Høier et al., 2024). Because negative symptoms impair a person's capacity to initiate, externally provided structure (regular visits, scheduled activities, predictable routines) is often more important than any internally motivated one. An Australian occupational therapy study found people with schizophrenia valued support that addressed cognitive needs, daily activities and meaningful engagement, and financial and accommodation security, above all else (Stewart et al., 2023). This is why our daily living support is delivered consistently, by the same people, every time. Predictability is not just operationally convenient. It is evidence-based.
It's worth remembering
Be the anchor point in someone's week. Bring a predictable rhythm to your sessions, and help the person build small, repeatable routines: a morning coffee, a regular walk, a weekly activity to look forward to. For many people with schizophrenia, consistent external structure is what makes a day hold together.
Support Identity, Not Just Symptoms
People with schizophrenia are not their diagnosis. They are people navigating complex lives and seeking connection, meaning and dignity, and when this is forgotten in how support is delivered, the consequences are serious and lasting. A 2025 study found that self-stigma, internalising the negative stereotypes encountered in media and healthcare settings, produces shame, delayed help-seeking and disengagement from treatment (Martí-García et al., 2025). A systematic review of recovery in schizophrenia found the theme running through every study was connection, with one's own sense of self and with the social world (Buckley-Walker et al., 2023). A 2025 scoping review confirmed personal recovery depends on five conditions: connectedness, hope, identity, meaning and empowerment (Melillo et al., 2025). As a support worker, you build connectedness through the relationship, model hope through your attitude, protect identity through person-first language, support meaning through meaningful activity, and foster empowerment through choice.
It's worth remembering
Notice what the person does well and mention it genuinely. Many people with schizophrenia spend years hearing about what they struggle with. Use person-first language in your notes, conversations and professional practice, always.
Recognise Relapse Early
Relapse in schizophrenia is common and significantly disabling, but it isn't sudden. Rates run at roughly 28% at one year and up to 80% over ten years, and each relapse responds less well to treatment (Kim & Kim, 2021). Relapse is the end point of a gradual process that begins days or weeks earlier, and proactive monitoring for early warning signs significantly reduces both relapse and rehospitalisation (McDonagh et al., 2021). Warning signs include increasing anxiety or suspiciousness, sleep disturbance, social withdrawal, loss of interest in valued activities, irritability, and subtle changes in speech. As a support worker you have more frequent contact with the participant than any clinician and know their baseline, so document any change specifically and objectively and report it without waiting for a pattern to become undeniable. If a participant is in acute crisis, distress that is placing themselves or others at risk, stay calm, speak slowly and quietly, don't argue with delusional content, and contact the treating team or community mental health service immediately. For immediate safety risk, call 000.
It's worth remembering
Document what you actually observe: specific behaviours, changes from baseline, the time and context. You are not diagnosing, you are observing and reporting, and that is both within your role and essential to it. Write your notes like they matter, because they do.
Meaningful Activity and Social Connection
Isolation is one of the greatest threats to wellbeing in schizophrenia. Perceived social support, particularly from significant others, is positively associated with recovery outcomes (Wakim et al., 2025), and community-based interventions that reduce isolation consistently lower rehospitalisation rates (Kim & Kim, 2021). Meaningful activity (volunteering, creative pursuits, community participation, exercise) directly supports recovery and reduces negative symptoms (Stewart et al., 2023), and aerobic exercise of at least 90 minutes a week produces measurable benefits in cognitive outcomes and daily functioning (Barlati et al., 2024). People with severely impaired social functioning often need positive withdrawal, carefully managed social exposure rather than pushed-for engagement (Ben Høier et al., 2024). A brief café visit, a familiar walk, or a regular drop-in at a community centre can build the sense of belonging that research identifies as central to recovery. What matters is whether it holds meaning for the person you're supporting, so ask, then build from there.
It's worth remembering
Community access should follow the participant's definition of what is worthwhile, not yours, and not the family's. Even small, regular community contact builds the belonging the evidence shows is foundational to recovery.
Address the Training Gap
Inadequate training is a structural problem that directly harms the people being supported. A 2025 review of fourteen studies, including several from Queensland, found limited knowledge of mental health conditions and recovery models was one of the most common barriers to effective support, leading to poor outcomes, worker stress and reduced capacity to advocate for participants (Njuguna et al., 2025). The same review found workers with good supervision, clear role definitions and genuine organisational support delivered significantly more person-centred, recovery-oriented care, while those without it reported role confusion and burnout that degraded the quality of care they provided. This is directly relevant to the NDIS context, where the Quality and Safeguards Commission requires evidence of worker capability.
It's worth remembering
Seek out relevant training through the NDIS Commission's worker orientation module, Mental Health First Aid Australia, and Queensland Alliance for Mental Health (QAMH). Document your learning. It strengthens your professional profile and improves the support you provide.
Families Are Partners, Not Peripheral
Family caregivers carry an important and often under-recognised load. A qualitative study of primary family caregivers in Beijing found they managed daily care, monitored for relapse and navigated treatment systems while receiving little to no professional backing themselves (Jia et al., 2019). In the NDIS context, a family member who is well informed and treated as a genuine partner provides more consistent support across the hours when you are not present. Communicating proactively and coordinating respectfully with families, always with the participant's consent, directly improves outcomes, and a 2025 scoping review confirms that involving families through a recovery-oriented rather than deficit-focused lens is one of the most effective strategies for improving long-term outcomes (Melillo et al., 2025).
It's worth remembering
Where appropriate and with the participant's consent, keep families informed about the things that matter. A brief, clear update about what went well or any changes you've noticed helps the whole support network provide better care. You are not working alone, and neither is the family.
References
- Anwar, A., Mustafa, A. M., Abdou, K., Rabie, M. A., El-Shiekh, R. A., & El-Dessouki, A. M. (2025). A comprehensive review on schizophrenia: Epidemiology, pathogenesis, diagnosis, conventional treatments, and proposed natural compounds used for management. Naunyn-Schmiedeberg's Archives of Pharmacology, 398(11), 15231–15255. https://doi.org/10.1007/s00210-025-04351-0
- Barlati, S., Nibbio, G., & Vita, A. (2024). Evidence-based psychosocial interventions in schizophrenia: A critical review. Current Opinion in Psychiatry, 37(3), 131–139. https://doi.org/10.1097/YCO.0000000000000925
- Ben Høier, N. Y., Mølstrøm, I.-M., Urfer-Parnas, A., Henriksen, M. G., & Nordgaard, J. (2024). Everyday life for patients with schizophrenia and severely impaired social functioning. Frontiers in Psychiatry, 15, Article 1399935. https://doi.org/10.3389/fpsyt.2024.1399935
- Buckley-Walker, K., Crowe, T. P., & Caputi, P. (2023). Exploring the lived experience of recovery processes in those with psychosis: A systematic review with thematic synthesis of qualitative evidence. Current Psychology, 42, 8435–8449. https://doi.org/10.1007/s12144-023-04360-3
- Haugom, E. W., Stensrud, B., Beston, G., Ruud, T., & Landheim, A. S. (2022). Experiences of shared decision making among patients with psychotic disorders in Norway: A qualitative study. BMC Psychiatry, 22, 192. https://doi.org/10.1186/s12888-022-03849-8
- Hormazábal-Salgado, R., Ferré-Grau, C., & Lleixà-Fortuño, M. (2024). Person-centred decision-making in mental health: A scoping review. Issues in Mental Health Nursing, 45(3), 220–231. https://doi.org/10.1080/01612840.2023.2288181
- Jia, F., Ding, Y., Zhao, D., Bian, X., Zhang, X., & Lv, Q. (2019). The burden, support and needs of primary family caregivers of people experiencing schizophrenia in Beijing communities: A qualitative study. BMC Psychiatry, 19, 75. https://doi.org/10.1186/s12888-019-2052-7
- Kim, S.-Y., & Kim, A. R. (2021). Effectiveness of community-based interventions for patients with schizophrenia spectrum disorders: A study protocol for a systematic review. Systematic Reviews, 10, 106. https://doi.org/10.1186/s13643-021-01662-0
- Lepping, P., Stanly, T., & Turner, J. (2020). The capacity of schizophrenia and bipolar disorder individuals to make autonomous decisions about pharmacological treatments for their illness in real life: A scoping review. Health Science Reports, 3(4), e179. https://doi.org/10.1002/hsr2.179
- Martí-García, C., Quemada-González, C., Aguilera-Serrano, C., Mejías Martín, Y., & García-Caro, M. P. (2025). Changing the narrative: A qualitative study on the impact of media portrayals on people with schizophrenia. PLOS ONE, 20(10), e0335008. https://doi.org/10.1371/journal.pone.0335008
- McDonagh, M. S., Dana, T., Kopelovich, S. L., Monroe-DeVita, M., Blazina, I., Bougatsos, C., Grusing, S., & Gaynes, B. N. (2021). Psychosocial interventions for adults with schizophrenia: An overview and update of systematic reviews. Psychiatric Services, 72(8), 892–902. https://doi.org/10.1176/appi.ps.202000649
- Melillo, A., Sansone, N., Allan, J., Gill, N., Herrman, H., Cano, G. M., Rodrigues, M., Savage, M., & Galderisi, S. (2025). Recovery-oriented and trauma-informed care for people with mental disorders to promote human rights and quality of mental health care: A scoping review. BMC Psychiatry, 25, 125. https://doi.org/10.1186/s12888-025-06473-4
- Njuguna, M., Ngune, I., & Middlewick, Y. (2025). Mental health support workers perspectives on barriers to and facilitators of the effective delivery of their roles: A systematic review and meta-aggregation. Community Mental Health Journal, 61(8), 1548–1573. https://doi.org/10.1007/s10597-025-01490-9
- Roebuck, M., Aubry, T., & Manoni-Millar, S. (2021). A qualitative study of the working alliance in the strengths model of case management with people with severe mental illness. Community Mental Health Journal, 58(5), 944–954. https://doi.org/10.1007/s10597-021-00903-9
- Solmi, M., Seitidis, G., Mavridis, D., Correll, C. U., Dragioti, E., Gupta, S., Fusté, A. R., & Tosato, S. (2023). Incidence, prevalence, and global burden of schizophrenia – Data, with critical appraisal, from the Global Burden of Disease (GBD) 2019. Molecular Psychiatry, 28, 5319–5327. https://doi.org/10.1038/s41380-023-02138-4
- Stewart, K., Hancock, N., Chapparo, C., & Stancliffe, R. J. (2023). Supports that help me to live well in the community: Experiences of people living with schizophrenia. Australian Occupational Therapy Journal, 71(1). https://doi.org/10.1111/1440-1630.12919
- Wakim, M. L., Zeenny, R., Sacre, H., & Salameh, P. (2025). The relationship between perceived social support and schizophrenia recovery. Scientific Reports, 15, Article 14721. https://doi.org/10.1038/s41598-025-19953-0
- Zarbo, C., Tasca, G. A., Cattaneo, A., & Menchetti, M. (2024). Burnout, working alliance, and ward atmosphere: A multisite study of mental health professionals and patients with schizophrenia. Brain and Behavior, 14(10), e70024. https://doi.org/10.1002/brb3.70024