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

Background: Treatment gap is a key indicator of adequacy of mental health services that drives policies and financial allocation for the sector. Impact of public health interventions on this gap is sparsely studied. Methods: To demonstrate reduction in treatment gap for Schizophrenia in rural south Indian setting following a community intervention program running in two taluks of Karnataka, India (Thirthahalli and Turuvekere) between July 2018 and February 2019. Population based sampling of persons with Schizophrenia who consented were included and subjects who migrated, died, had changed/other diagnosis, did not consent were excluded Prevalence was measured by adding already existing cases with the ones identified by way of house-to-house survey, conducted by trained Accredited Social Health Activists (ASHAs). Screen-positives were further scrutinized by research social workers and psychiatrists to confirm the diagnosis. Gap was calculated by noting difference between target population and ones who had not contacted any service even once for psychiatric treatment. Results: In Thirthahalli, out of 364 patients, 14 had not contacted any service even once, pegging the gap at 3.84%. In Turuvekere, out of 236 cases, 29 had not contacted, pegging the gap at 12.28%. Overall, 7.16% was the gap in both taluks. For the taluk of Thirthahalli, the previous treatment gap was measured as 58% for Schizophrenia in 2009 by the authors; thus, reducing it by almost 54% over one and a half decade of this intervention. Conclusion: Meaningful reduction of gap for schizophrenia is a feasible target. Policies commensurate with this aim should be considered.