Scaling up Global Mental Healthcare, Starting with Schizophrenia

An article in Schizophrenia Bulletin makes a strong case for a scaling up of schizophrenia care that could yield breakthroughs in treatment for the condition and, ultimately, many other mental health disorders. Such a scaling up would involve breaking down significant barriers but could yield significant breakthroughs in treatment.

The report starts with the premise that universal healthcare now available in many parts of the world creates the perfect environment for the pursuit of better outcomes in mental health disorders. “Starting with schizophrenia, arguably the most visible and stigmatized mental disorder in any community, not only invokes the principle of the right to care for the most disabled and the most disadvantaged, but also frames a path towards the ultimate universalization of care for the full range of mental disorders,” the study authors wrote.

Among the key points raised in the article is the fact that evidence supporting safety and efficacy of pharmacologic schizophrenia treatment continues to grow. While expanding that care to lower resource settings would be a challenge, particularly in the areas of cost of treatment and training and deployment of qualified community-based workers, the potential benefits in overcoming those barriers to those suffering from mental health disorders would be incalculable.

One challenge the authors covered at length is the idea that universal healthcare logically focuses on conditions based on the metrics of mortality and cost-effectiveness for the covered population.

“Thus,” they noted, “the conditions associated with the highest populations burden of mortality and the most cost-effective interventions are prioritized, with coverage for other conditions considered a future goal. Not surprisingly, interventions for schizophrenia are not attractive when assessed with these metrics, for the condition is relatively rare and accounts for a small share of the global number of deaths….Yet…we need to ensure that a narrow focus on burden and cost-effective interventions must not be allowed to outweigh the enormous health, economic and social hardships, including the significantly increased mortality rates and some of the worst instances of human rights abuse witnessed in modern times, in ensuring the inclusion of a basic package of services for schizophrenia.”

The authors makes the case through a comprehensive look at what interventions should be proposed for scale-up; how should they be delivered; and what the barriers to delivery are and how to address them. They also looked closely at case studies in Brazil and China, both of which have embarked on ambitious programs to expand coverage of care for people with schizophrenia.

“…The experiences of upper middle income countries like Brazil and China show that political commitment, allocation of transitional financial resources, a commitment to an integrated approach with a strong role for community based institutions and providers, and a progressive realization of coverage (both in terms of area and range of services), are the key ingredients for scale up of services for schizophrenia,” the study authors concluded.