Low Treatment Gap for Schizophrenia in Rural India: A Step Toward Taluk Mental Health Program

Background In India, an estimated 3.5 million are affected with schizophrenia, of which more than two-thirds belong to the rural demography. Schizophrenia is one of the most disabling illnesses, causing 10% of the disability adjusted life years, making it a public health concern. We aimed to estimate the treatment gap for schizophrenia in a rural South Indian setting following a community intervention program implemented in two administrative blocks (Thirthahalli and Turuvekere) in the state of Karnataka, India.

Methods Population-based screening was conducted by trained Accredited Social Health Activists (ASHAs) to identify persons with symptoms of schizophrenia. Research social workers and psychiatrists interviewed screen-positives to confirm the diagnosis. Prevalent cases were enumerated by adding those already registered under the program to those newly identified through house-to-house screening. The treatment gap was calculated by subtracting the "target population" from those who had received psychiatric treatment at least once.

Results In Thirthahalli, of 364 patients, 14 had not received any treatment, indicating a treatment gap of 3.84%. In Turuvekere, out of 236 cases, 29 had not received treatment, indicating a treatment gap of 12.28%. Overall, the treatment gap in both administrative blocks was 7.16%.

Conclusion Meaningful reduction of treatment gap for schizophrenia is a feasible target at sub-district levels. Policies commensurate with this aim should be considered.