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Community Care Boosts Treatment of Mentally Ill in Developing Countries

FILE - Community health worker Jennifer Pascal (L) makes a house visit to Mary Smith, a former addict who was treated at Boston Healthcare of the Homeless Program's Suboxone clinic and now lives in supportive housing, in Boston, Massachusetts.
Experts say less than 10 percent of people with mental illness in low-income countries receive treatment. A new study shows community-based care is an effective strategy for treating individuals with schizophrenia.

Researchers found the most successful way to treat people with mental illness in resource poor countries is for the care to come to them.

In the first rigorous trial of community-based care for the mentally ill, researchers looked at the benefits of home visits at three sites in India, comparing the outcomes to those who received their care exclusively from mental health clinics. The study involved schizophrenic patients, ages 16 to 60.

A professor of community psychiatry at the Institute of Psychiatry at Kings College London, Graham Thornicroft, led the study.

“So, what we wanted to do in this study is to find out, can we develop a relatively simple and affordable type of treatment that will increase the number of people who get treatment and increase the quality of care,” he said.

Thornicroft said trained health care workers visited the homes of 187 schizophrenic patients, making sure they took their anti-psychotic medicine regularly and educating family members on how to care for loved ones with mental illness. The patients also visited mental health clinics for professional care.

Their progress was compared to that of 95 patients who received their care exclusively at mental health facilities.

A year later, Thornicroft said researchers noted a significant improvement among patients who had been visited regularly by health care workers.

“For example, voices or delusions were less in the community treatment option. Secondly, the levels of disability were lower when people had community care as well as the medical treatment [in clinic] and third, people were more often likely to take their medication if they had the close support of [someone] coming to visit their homes rather than getting no follow-up between the doctors’ visits,” said Thornicroft.

In a study published in the journal The Lancet, researchers noted community intervention was more expensive than clinical care alone.

But Thornicroft said this has to be weighed against the enormous social costs of not treating individuals with schizophrenia and other debilitating mental conditions.