Schizophrenia and other psychoses are among the leading causes of the global burden of disease in low-, middle-, and high-income countries alike. As of 2006, and assuming a point prevalence of 4.6 per 1000 population , at least 25 million people in low- and middle-income countries (LMIC) were suffering from schizophrenia, a disorder that, according to estimates for 2004, accounted for 1.1% of all Disability Adjusted Life Years and 2.8% Years Lived with Disability . Other research suggests that schizophrenia and other psychoses are associated with excess mortality, suicide in particular, as well as stigma, discrimination, and violations of human rights [2-6]. In low- and middle-income countries the burden of schizophrenia and other non-affective psychoses is made comparatively greater because of a lack of mental health resources that can provide effective treatments and, thus, decrease the symptom severity and disability associated with these conditions [7,8]. This is certainly the case in Nigeria where a recent study found that non-affective psychoses were relatively common (1.1% prevalence) but frequently went untreated , undoubtedly because of a scarcity of mental health resources . This application for an exploratory planning grant (R21) proposes to undertake activities whose ultimate goal is the development of a package of care for individuals with psychosis and their caregivers in one catchment area of Nigeria. To achieve this goal, we propose to establish a collaboration between the London School of Hygiene and Tropical Medicine and Institute of Psychiatry, Kings College London, and the University of Ibadan. The collaboration will build on: 1) the long and impressive history of psychiatric and mental health services research in Nigeria [11-52];2) the evidence presented in the landmark Global Mental Health and Packages of Care series in The Lancet [7,8,53-56] and PLoS Medicine [57-63], respectively;and 3) the strategies for scaling up as outlined by the WHO mhGAP programme . Together, the investigators who will lead the proposed project will consider, in a local Nigerian setting, the needs of persons with psychosis and their caregivers, the available mental health resources, and then formulate an evidence-based intervention package of care that will utilize non-specialist health workers (e.g., primary care physicians, nurses, and community health workers) working in partnership with the available psychiatric specialists, to create a program that will deliver services in community based settings [60,64,65].
Schizophrenia and other psychoses impose a huge burden of disease in low- and middle-income countries. The aim of this exploratory project is to design an evidence-based, feasible, acceptable, and locally appropriate community-based rehabilitation package of care and that can be implemented in two local government areas of Osun State, Nigeria.