Psychological Medicine

Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs 1

a1 Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
a2 Mental Health: Evidence and Research, Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland

Article author query
srinivasa murthy r   [PubMed][Google Scholar] 
kishore kumar kv   [PubMed][Google Scholar] 
chisholm d   [PubMed][Google Scholar] 
thomas t   [PubMed][Google Scholar] 
sekar k   [PubMed][Google Scholar] 
chandrashekar cr   [PubMed][Google Scholar] 


Background. In resource-poor countries, there remains an alarming treatment gap for people with schizophrenia, particularly those living in rural areas. Decentralization of mental health services, including community-based outreach programmes, represents one obvious strategy for bringing appropriate care to these communities. This study set out to assess the costs and effects of such a programme in rural Karnataka in India.

Method. Eight rural communities were visited by an outreach team, who identified cases of drug-naive or currently untreated schizophrenia. Recruited cases were provided with appropriate psychotropic medication and psychosocial support, and after obtaining informed consent were assessed every 3 months over one and a half years on symptomatology, disability, family burden, resource use and costs. A repeated-measures analysis was carried out to test for significant change in these outcome measures over this period.

Results. A total of 100 cases of untreated schizophrenia were recruited, of whom 28% had never received antipsychotic medication and the remaining 72% had not been on medication for the past 6 months. Summary scores for psychotic symptoms, disability and family burden were all reduced significantly, with particular improvement observed at the first follow-up assessment. Increases in treatment and community outreach costs over the follow-up period were accompanied by reductions in the costs of informal-care sector visits and family care-giving time.

Conclusions. Efforts to organize community-based care such as outreach services for people with schizophrenia living in more remote areas of resource-constrained countries can bring substantial benefits to patients and families alike.

c1 Dr D. Chisholm, EIP/FER/CEP, World Health Organization, Geneva 1211, Switzerland. (Email:


1 The views expressed are those of the authors and not necessarily those of the organizations they represent.