Schizophrenia is a severe and disabling mental illness, which can lead to problems with work and relationships, being the victim of discrimination and violence, and early death. In low-income countries, such as Ethiopia, up to 90% of people with schizophrenia do not access any treatment. One of the main reasons for this is the severe shortage of mental health professionals.
To understand the best way to support people with schizophrenia in rural Ethiopia, experts designed and tested a programme known as community-based rehabilitation. Community-based rehabilitation involved lay people, with no experience in mental health care, supporting people with schizophrenia and their families in their homes.
Support was given in the form of providing help to get back to work, community, and family life; making preparations for a crisis; and help to access medication at the local health centre. Community-based rehabilitation workers also tried to change negative attitudes about mental illness in the local community, and asked individual community members to provide social support, food and help with medication costs.
Seventy-nine people with schizophrenia, in 27 villages in Ethiopia, were randomly allocated to take part in community-based rehabilitation for one year, in addition to receiving treatment from nurses at the health centre.
Eighty-seven people with schizophrenia in 27 villages were allocated to only receive treatment at the health centre. The study was funded by the Wellcome Trust and builds on ground-breaking research by Ethiopian colleagues which showed that mental healthcare for people with schizophrenia can be delivered effectively by nurses in local health centres (primary care).
Asher said :“We found that after one year, people with schizophrenia who took part in community-based rehabilitation were less disabled, were more likely to use the health centre and had fewer symptoms compared to those who had not. However, there were no differences in employment or discrimination rates between the two groups.
“To our knowledge, this study is the first of its kind globally. Our findings suggest that in low-income countries community-based rehabilitation can help with the recovery of people with schizophrenia, when delivered alongside medication from a local health centre. As community-based rehabilitation can be delivered by lay people, these findings are particularly relevant for places where there are few mental health professionals,” Asher added.