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Packages of mental health care for low and middle-income countries

04 November 2009

Packages of care for Schizophrenia in low and middle-income countries, by Professor Graham Thornicroft, Institute of Psychiatry (IoP) at KCL has been published by PLoS Medicine. It is the third in a major new series of articles which address the inequity known as the “treatment gap” in low and middle income countries (LAMICs) - where over 90% of people with mental, neurological, and substance use (MNS) disorders go untreated.

The paper was funded through a National Institute for Health Research (NIHR) Applied Programme grant awarded to the NIHR specialist Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and the IoP, KCL and written in collaboration with colleagues at Universidade Federal de Sao Paulo Brazil, Schizophrenia Research Foundation, Chennai, India and CBM International, Abuja, Nigeria.

It provides a comprehensive summary of detection, pharmacotherapy, and delivery of effective interventions for schizophrenia suggesting that recovery in LAMICs can be achieved by using antipsychotic medication, along with psychosocial education and/or family interventions. The authors state that the use of psychosocial educational strategies can help to improve knowledge and awareness of the condition, lower stigma and improve understanding of the role of medicine and the importance of compliance to treatment for prevention of relapse. Currently more than a two thirds of people in LAMICs with chronic schizophrenia remain untreated.

Professor Thornicroft and Professor Vikram Patel (Professor of International Mental Health and Wellcome Trust Senior Clinical Research Fellow at the London School of Hygiene & Tropical Medicine, who is based at Sangath in Goa, India) are Guest Editors for this PLoS Medicine series which examines the evidence on which treatments should be delivered in LAMICs where specialists are scarce.

The series covers six disorders that have a major global burden across the life course: depression, epilepsy, schizophrenia, alcohol use disorders, dementia, and ADHD. The series coincides with the launch of the Centre for Global Mental Health, a collaborative initiative of the London School of Hygiene & Tropical Medicine and the King’s Health Partners Academic Health Sciences Centre. Professor Martin Prince (Co-Director of the Centre with Professor Patel) has written the fifth article in the PLoS series on dementia.

In an introductory paper to the series, Patel and Thornicroft say that although the specific treatments differ between disorders, there are also 'many shared themes related to the delivery of these treatments.' For example:

  • Detection and diagnosis of the more common disorders (like depression and alcohol use disorders) can be reliably carried out using brief screening questionnaires
  • A combined package of medication and psychosocial treatments works for treating these six disorders, but not all patients need all of the treatments
  • People with almost all of these disorders need continuing care and help to maintain regular use of medication for extended periods to achieve the best outcomes
  • Non-specialist health workers can safely and effectively deliver treatments for MNS disorders within a functioning primary health care system. But collaborative care models (where non-specialists get expert input from specialists) greatly enhance the effectiveness and sustainability of such non-specialist health worker-led care programs.

Professor Thornicroft said: 'To the best of our knowledge the series is the first attempt to collect comprehensive reviews of six leading, and mostly neglected, MNS disorders in an open access venue that allows immediate and full access to everyone including those living and working in low and middle income countries.'

He continues: 'The aim of the series is to serve as a valuable resource for health professionals, policy makers, and health workers working to improve the care and treatment of those struggling with MNS disorders in settings where specialist resources are scarce and where treatment gaps are large.'

PLoS Medicine is an open access, freely available international medical journal which publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. To view a copy of Packages of Care for Schizophrenia in low and middle-income countries and the rest of the series go to:



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