One of the problems faced by people with schizophrenia is their difficulty in finding and holding down a job. Without work their sense of rejection, and isolation from the working community, increases the stigma that this disease carries.

Each year Eli Lilly, the pharmaceutical company, presents an award to those people working in primary healthcare who have done most to integrate people with schizophrenia into their local community. This year it was awarded to Dr Colin Guthrie, a Glasgow GP, and Dr Alistair Wilson, a local community psychiatrist, who had together launched a bicycle repair and sales shop run by eight of their psychotic patients.

Dr Guthrie and Dr Wilson came to the conclusion that even when the medical care of their patients was good, there was still a gap. They had tried to make certain that the patients were treated early, and that when indicated they were prescribed the new atypical antipsychotic drugs. This is often an important factor in early treatment, as the newer medication has fewer side-effects and therefore affects people's lifestyle less.

Even so, too many of the patients had nothing to do all day, and their sense of achievement and pride was dented. The patients felt that the hospital-based occupational therapy concentrated on tasks that were too repetitive, unrewarding and failed to give the opportunity for patients to mix with local communities.

Running a bicycle shop seemed to be an answer. It fulfilled a need in a poor area of Glasgow. The shop didn't charge children, or for small repairs, and thereby became a valued local service. It also succeeded in making Pounds 1,200 a month from larger repairs and from the sale of bikes. The company is owned by its members, the patients.

The patients have done well medically, and in particular there has been a noticeable reduction in the severity of the more obvious symptoms they experience. In addition their lifestyle, and in consequence their enjoyment of life, has benefited from their integration with the community. They have enjoyed learning and practising the skills of bicycle repair. As one worker says: "I don't feel like a patient when I come here."

Presenting the award, Dr Adrianne Reveley, a specialist in the treatment of schizophrenia and a consultant at the Maudsley Hospital, London, said that, with the older treatments, schizophrenics "could be picked out from 100 paces because of the terrible side-effects of the medication, which too often resulted in blank faces and twitching limbs". She added that the newer treatments do not cause these side- effects nearly so much, but "in Britain in the 21st century, not everyone is offered the choice of the newer drugs".

The reason seemed to be that the newer anti-psychotics were more expensive than the old, "which cost only pennies". But this reasoning took no account of the fact that, if a drug was so badly tolerated that a patient with schizophrenia did not take it at all, the resulting expense to the NHS, the social services and society in general could - as a result of lack of any treatment - be much greater.