Schizophrenia treatment better at home

Mental hospitals may not be the best option for lakhs of schizophrenia patients in India who can be treated at home with better success with the help of trained community health workers, medical researchers have found.

When compared with hospital based treatment, care at home involving health workers, reduces the disability of the patients by an additional 20 per cent, improving their economic productivity. Also there is better adherence to medicines.

One of the common mental disorders, schizophrenia – characterised by breakdown in thinking and poor emotional response — strikes a person before 25 years and turns chronic in a large number of people.

Like other chronic diseases, it is managed either at home or in hospitals depending on the severity of the condition. Now medical researchers in India and the UK claim that the success rate improves if the treatment is continued at home involving health workers.

The finding is based on a major trial involving 187 schizophrenia patients at Kancheepuram (Tamil Nadu), Goa and Satara (Maharashtra); they found significant symptom and disability reduction.

 The trial was carried out between January 1, 2009 and December 31, 2010 and its results were published in the March 5 issue of The Lancet. 

The selected patients had symptoms for seven years on an average and were diagnosed with “moderate to severe” schizophrenia.

The best results came from the Tamil Nadu sites, which are rural pockets without any local mental health service. “For the first three months, the health workers came to a patient’s home every 10-15 days, but interaction with the health workers gradually decreased in the subsequent months. For a resource-scare community, the community-care model would expand treatment coverage,” said lead researcher Sudipto Chatterjee, who is associated with Sangath, a non-governmental organisation in Goa.

Patients receiving the community intervention were three times more likely to continue taking their antipsychotic medication than those given usual care.

The researchers used lay persons to deliver a package of personalised treatments to patients at home, under supervision from psychiatric social workers. There was also linkage with practising psychiatrists at the back end.

“This is the best scalable model for Indian mental health programme. It will, however, come with an additional cost of Rs 9,500 per person per year on account of supervision,” Vikram Patel, one of the co-authors of the study from London School of Hygiene and Tropical Medicine told Deccan Herald.

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