Community based treatment for schizophrenia is effective in low income countriesBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1984 (Published 06 March 2014) Cite this as: BMJ 2014;348:g1984
Schizophrenia can be treated successfully by mobile community teams in India, a randomised trial has shown.1 Such an approach could be valuable in other low and middle income countries that have few mental health specialists, the authors say.
The Community Care for People with Schizophrenia in India (COPSI) trial found that treatment in the community led by community health workers is more effective than standard facility based care at reducing disability and psychotic symptoms and making sure that patients take their antipsychotic medication.
The study, funded by the Wellcome Trust, randomised 187 patients with schizophrenia to community care plus facility based care and 95 to facility based care alone at three sites in India. Patients allocated to community care were visited and treated by lay health workers, who were trained to provide home care and supervised by psychiatric social workers.
The study, published in the Lancet, showed that after 12 months, the symptoms and disabilities on the Positive and Negative Syndrome Scale (PANSS) and the Indian Disability Evaluation and Assessment Scale (IDEAS) were lower in the group given community and facility based care compared with scores in patients who received facility based care alone (PANSS adjusted mean difference −3.75, 95% confidence interval −7.92 to 0.42; P=0.08; IDEAS −0.95, −1.68 to 0.23; P=0.01). However, no difference was found in the proportion of patients who had a reduction of more than 20% in overall symptoms.
Patients in the community care group were almost three times more likely to continue taking their antipsychotic medication than those given the usual care, the study found.
However, costs in the community group were higher. Over the year’s study the cost of care was an average of 9500 rupees (£92; €112; $153) higher than that in the facility based group.
Study leader, Graham Thornicroft, professor of community psychiatry from the Centre for Global Mental Health, King’s College London, Institute of Psychiatry, said: “In many low income countries, fewer than 10% of people with mental health problems receive any treatment. There may be just a handful of psychiatrists, and in some countries, there are no mental health specialist doctors at all.”
He added: “People with schizophrenia can be treated successfully using mobile community teams in a resource poor country. By moving treatment into the community, it is possible to scale up services where they are needed and scarce, as is the case in many low income and middle income countries.”
Cite this as: BMJ 2014;348:g1984
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