Xiaofen Wang, Qi Tang, Huilan Xu, Matcheri S Keshavan, William S Stone, Ezra S Susser, Lawrence H Yang, Michael R Phillips
Reasons for persistent non-treatment indicate that after 20-plus years of illness, some individuals with chronic, untreated schizophrenia in LMICs and their family caregivers may accommodate to the situation and have little hope or interest in changing the status quo. The expansion of mental health services to previously underserved communities and the provision of free treatment and follow-up services to these individuals must be accompanied by promotion efforts that improve public knowledge about mental illness and change patients' and caregivers' negative attitudes about treatment.
AIM: Assess reasons individuals with chronic schizophrenia in rural communities of low- and middle-income countries (LMICs) often remain untreated.
METHOD: Reported reasons for the non-treatment of 201 community-dwelling individuals with untreated chronic schizophrenia (mean duration of illness, 23.3 years) in rural China were obtained from patients and caregivers. After providing information about the illness and how to apply for free treatment, a follow-up telephone survey 25 months later assessed reasons for persistent non-treatment.
RESULTS: Common reasons for non-treatment over the long course of the illness provided at baseline were family financial difficulties (40.8%), caregivers' failure to identify the mental illness (19.9%), and patients' refusal to take medication (14.9%). Among the 185 patients followed up, only 45 (24.3%) completed at least 1 month of treatment. Reasons for non-treatment included patients' refusal to take medication (18.4%); caregivers' forgetting to administer medication (15.1%) or inability to monitor medication (9.2%); caregivers' belief that the patient did not need treatment because they were elderly (14.1%), that the condition was incurable (7.0%), or that the symptoms were not severe (5.4%); medication side-effects or lack of immediate symptomatic improvement (11.4%); and financial difficulties (8.6%) or difficulty getting free medication (3.2%).
CONCLUSIONS: Reasons for persistent non-treatment indicate that after 20-plus years of illness, some individuals with chronic, untreated schizophrenia in LMICs and their family caregivers may accommodate to the situation and have little hope or interest in changing the status quo. The expansion of mental health services to previously underserved communities and the provision of free treatment and follow-up services to these individuals must be accompanied by promotion efforts that improve public knowledge about mental illness and change patients' and caregivers' negative attitudes about treatment.