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 [1], 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 [2]. 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 [9], undoubtedly because of a scarcity of mental health resources [10]. 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 [2]. 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].

Public Health Relevance

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.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-ICP2-B (51))
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Pringle, Beverly
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London School/Hygiene & Tropical Medicine
United Kingdom
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Morgan, Craig; Hibben, Maia; Esan, Oluyomi et al. (2015) Searching for psychosis: INTREPID (1): systems for detecting untreated and first-episode cases of psychosis in diverse settings. Soc Psychiatry Psychiatr Epidemiol 50:879-93