Near zero treatment gap for schizophrenia: Can it be reality in rural India?

BACKGROUND: Treatment gap, conceptualized as a proportion of eligible persons not having access to treatment, is a key indicator of adequacy of mental health services of a state, driving policies and financial allocation for the sector. Impact of public health interventions on the gap is not studied however METHODS: We examined the impact of two community intervention programs (for persons with schizophrenia) running in two taluks of Karnataka, India (Thirthahalli and Turuvekere) on the reduction of treatment gap. Prevalence (target population) was measured by adding up the already existing cases with the ones identified by way of house-to-house survey, conducted by Accredited Social Health Activists (ASHAs) who were trained in a simple screening tool. Screen positives were further scrutinized by research social workers and psychiatrists to confirm the diagnosis. Gap was calculated by noting the difference between the target population and the ones who had not contacted the service even once RESULTS: In Thirthahalli, out of 364 patients, 14 had not contacted the services even once, pegging the gap at 3.84%. In Turuvekere, out of 236 cases, 29 had not contacted the services, pegging the gap at 12.28%. 7.16% was the gap in both taluks put-together. CONCLUSION: Meaningful reduction of gap for schizophrenia is a feasible target to achieve. Policies commensurate with this aim should be considered. Principal worker: Naveen Kumar C, MD, DPM. Professor & Head, Community Psychiatry Unit Department of Psychiatry.National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru –560029, India. Email: cnkumar1974@gmail.com Ph: 9448504903