Study Shows Community-Based Care For Schizophrenia Works

Community intervention was found to be more effective at reducing symptoms and disabilities in schizophrenics compared to facility-based care.

AsianScientist (Mar. 13, 2014) – The first randomized trial to rigorously test community-based care for people with schizophrenia in India shows that treatment led by lay health workers is more effective than standard facility-based care at reducing disability and psychotic symptoms, and ensuring that individuals continue their antipsychotic medication.

“In many low-income countries, fewer than 10 percent 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 doctor at all,” said Graham Thornicroft, of King’s College London, Institute of Psychiatry, who led the research.

The COmmunity care for People with Schizophrenia in India (COPSI) Trial, published in The Lancet, randomly assigned individuals with moderate to severe schizophrenia aged 16 to 60 years to receive either collaborative community-base care plus facility-based care (187 patients) or facility-based care alone (95) at three sites in India.

For the community intervention, lay health workers were trained to deliver a package of personal, evidence-based treatments to the patient at home, under close supervision from psychiatric social workers (intervention coordinators), and also to support family members.

The study’s main measures of success were changes in symptoms and disabilities over 12 months rated on the Positive and Negative Syndrome Scale (PANSS) and the Indian Disability Evaluation and Assessment Scale (IDEAS). The lower the rating, the better the level of function.

After one year, total PANSS and IDEAS scores were lower in the community intervention group than in the usual care group. In particular, a significant symptom and disability reduction was noted at the site of Tamil Nadu, the most rural and deprived of the study sites. Additionally, patients receiving the community intervention were almost three times more likely to continue taking their antipsychotic medication than those given usual care.

However, community-based care was no more effective for reducing stigma and discrimination, lessening caregiver’s burden, or increasing knowledge about the disorder amongst family members.

Furthermore, the costs in the intervention group were higher than in the usual care group.

“The average greater cost for participants in the intervention group over the study period was almost INR 9500 (roughly US$153); therefore, a judgment should be taken as to the value in terms of the clinical and social improvements identified for a group of highly vulnerable people,” the authors said.

The article can be found at: Chatterjee et al. (2014) Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): a randomised controlled trial.

——

Source: King’s College London; Photo: Sistak/Flickr/CC.

Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

Asian Scientist Magazine is an award-winning science and technology magazine that highlights R&D news stories from Asia to a global audience. The magazine is published by Singapore-headquartered Wildtype Media Group.

Related Stories from Asian Scientist