Academic journal article Bulletin of the World Health Organization

Service Availability and Utilization and Treatment Gap for Schizophrenic Disorders: A Survey in 50 Low- and Middle-Income countries/Disponibilite et Utilisation Du Service et Ecart De Traitement Des Troubles Schizophreniques: Une Etude Dans 50 Pays a Revenu Faible et moyen/Disponibilidad Y Utilizacion De Los Servicios Y Desigualdad En El Tratamiento De Trastornos Esquizofrenicos: Encuesta Realizada En 50 Paises De Ingresos Bajos Y Medios

Academic journal article Bulletin of the World Health Organization

Service Availability and Utilization and Treatment Gap for Schizophrenic Disorders: A Survey in 50 Low- and Middle-Income countries/Disponibilite et Utilisation Du Service et Ecart De Traitement Des Troubles Schizophreniques: Une Etude Dans 50 Pays a Revenu Faible et moyen/Disponibilidad Y Utilizacion De Los Servicios Y Desigualdad En El Tratamiento De Trastornos Esquizofrenicos: Encuesta Realizada En 50 Paises De Ingresos Bajos Y Medios

Article excerpt

Introduction

Schizophrenic disorders are chronic and severe mental conditions that affect 26 million people worldwide and result in moderate or severe disability in 60% of cases. (1) Due to their early onset and debilitating effects, schizophrenic disorders rank fifth among men and sixth among women as a leading cause of years lived with disability. Schizophrenic disorders also comprise roughly 1% of the global burden of disease (GBD), a fraction that is considered moderate to high. They also represent 1.3% of the disability-adjusted life years (DALYs) overall and 1,2%, 1.6% and 0.8% in upper-middle-income countries, lower-middle-income countries and low-income countries, respectively. (2)

Mental health services play a central role in the treatment of people with schizophrenic disorders, as they act both as direct providers of care and as supporters of primary care practitioners. Recent data indicate that in low- and middle-income countries, the treatment of people with schizophrenic disorders using first-generation antipsychotics and psychosocial interventions (family and psycho-educational), when delivered via a community-based service model, represents a cost-effective use of health resources. (3,4) Despite this, only a minority of people with schizophrenic disorders receive care from formal mental health services. (5)

Access to specialized services is a key measure in evaluating the capacity of health-care systems to reduce the untreated burden of schizophrenic disorders. This measure requires information on how many people with schizophrenic disorders have access to care out of the total number of people in need of services. In addition to access, another key indicator is service utilization, which describes the services patients receive and the balance between outpatient and inpatient care. In an earlier report, Kohn et al. (6) described the treatment gap as the absolute difference between the true prevalence of a disorder and the treated proportion of individuals affected by the disorder. The World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) (7) comprises information on mental health systems in low- and middle-income countries and thereby allows, for the first time, an in-depth analysis of the availability of mental health services in these countries and a framework for ascertaining the accessibility of service delivery.

The goal of this paper is to utilize the WHO-AIMS instrument to analyse the accessibility of mental health services for people with schizophrenic disorders in 50 low- and middle-income countries, to estimate the magnitude of the treatment gap and to describe health service utilization among people affected with schizophrenic disorders.

Methods

The instrument: WHO-AIMS

The WHO-AIMS instrument consists of 155 input and process indicators covering six domains: (7-8) (i) policy and legislative framework; (ii) mental health services; (iii) mental health in primary care; (iv) human resources; (v) public information and links with other sectors; and (vi) monitoring and research. This paper reports on selected indicators drawn from the second and forth domains.

Country-based investigators collected data for the indicators from all available sources (e.g. national and local statistics and surveys specifically planned to collect WHO-AIMS data) using clear definitions and explicit instructions. Country, regional and WHO headquarters-based staff provided technical assistance and supervision.

The sample

This paper, which focuses on mental health services for adults, draws on cross-sectional data from low- and middle-income countries or territories that completed a WHO-AIMS assessment between March 2005 and June 2010. Diagnostic data were available for only 50 of the 63 countries that completed this assessment. Thus, 13 countries were excluded because treated prevalence and treatment gap rates could not be calculated due to missing data and errors in data collection (e. …

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