Community-based rehabilitation (CBR) provides care for people with physical disabilities in low-income countries where specialised resources are scarce. Could this strategy be adapted to meet the complex needs of people with severe mental disorders? Research conducted by the Ashagram Trust and supported by the London School of Hygiene and Tropical Medicine adapted and tested CBR for chronic schizophrenia in rural India.

The Ashagram (‘village of hope’) Trust is a non-governmental organisation based in Barwani district in the state of Madhya Pradesh, which works towards the rehabilitation of people affected by leprosy. Ashagram extended their work with disabled persons to include those affected by severe mental disorders, especially schizophrenia. The team of researchers adapted the CBR model through consultation with patients, families and key community members. The model had three tiers:

• out-patient clinical care by a psychiatrist
• mental health workers drawn from the local community
• local health groups, including family members and key community figures, to plan relevant rehabilitation measures and reduce social exclusion.

All patients receive appropriate antipsychotic medication. One year after the start of the programme, researchers compared the progress of 127 patients in the CBR programme with that of 80 people receiving out-patient care. They found that:

• 63 per cent of patients were fully compliant in the CBR group, compared with 46 per cent in the out-patient care group.
• For fully compliant patients, CBR gives better improvements in the severity of their illness than out-patient care alone.

Out-patient care is often the only type of mental healthcare available in developing countries. It may be an effective way of providing services to a large population. But time and staffing constraints limit the level of care available for chronically ill patients. CBR offers a number of advantages over out-patient care, as it:

• involves the active participation of patients and their families
• addresses economic, cultural and geographic barriers in accessing care
• provides a range of mental health services at home
• improves communication by employing local community members as mental health workers
• empowers patients and their families to become informed partners in the planning and implementation of feasible rehabilitation strategies
• requires low levels of technical expertise to deliver services.

However, CBR is more costly in terms of time and resources. Cost-effectiveness was not measured in this study and should be included in a larger systematic trial of this approach.

Source(s):
‘Evaluation of a community-based rehabilitation model for chronic schizophrenia in rural Indai’, British Journal of Psychiatry 182: 57-62, by S. Chatterjee, V. Patel, A. Chatterjee and H. Weiss, 2003

Funded by: Action Aid, India; UK Medical Research Council; Wellcome Trust

id21 Research Highlight: 26 February 2003

Further Information:
Vikram Patel
Sangath Centre
841/1 Alto Porvorim
Goa 403521
India

Fax: +91 832 415244
Contact the contributor: vikpat@goatelecom.com

London School of Hygiene and Tropical Medicine, UK

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