Psychological Medicine



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


R. SRINIVASA MURTHY a1, K. V. KISHORE KUMAR a1, D. CHISHOLM a2c1, T. THOMAS a1, K. SEKAR a1 and C. R. CHANDRASHEKAR a1
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] 

Abstract

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.


Correspondence:
c1 Dr D. Chisholm, EIP/FER/CEP, World Health Organization, Geneva 1211, Switzerland. (Email: ChisholmD@WHO.int)


Footnotes

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



Metrics
Related Content