Innovative home based assertive outreach service for treatment of schizophrenia in Larkano, Pakistan (SOUL): Programme implementation and outcomes at the end of five years

Abstract

Introduction

There is a significant service gap in provision of essential treatment to patients with severe mental disorders in low-income countries, which leads to increased mental health disability and bigger disease burden on the families and society. The SOUL programme is a first of its kind in the country, which utilizes assertively engaging patients at their homes.

Objectives

The key objectives are early recognition, treatment and psychosocial support to patients with the diagnosis of schizophrenia. Additional objectives include social recovery of the patients, psycho education to family members and generating clinical and functional outcomes.

Methods

Programme design developed by host psychiatry department through stakeholder consultation. Training was undertaken for programme team and included training on use of outcome measures namely Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF). Hosting carers and families meetings on regular intervals serve the purpose of family psycho-education and receiving informal feedback about the service.

Results

Preliminary findings on clinical and functional outcomes of cohort of 125 patients recruited over continual basis over 5 years are presented. Complex community intervention shows significant change in all outcome scales (with good effect size) with before and after analysis at one year. The programme demonstrated excellent engagement with patients and very low dropout rate.

Conclusions

Low cost community intervention involving trained doctor and psychiatric nurses working under close supervision of a senior psychiatrist is feasible and achievable and can lead to robust improvements in symptoms and functional outcomes for patients with schizophrenia.

Disclosure of interest

The author has not supplied his declaration of competing interest.