Community Based Primary Care for Mental Illness in Developing Countries

In developing countries persons with severe mental illness who do not receive treatment are at risk of premature death. Even in countries with extensive networks of primary care stations such as Indonesia (Puskesmas), existing resources are too few to do more than diagnose and occasionally provide medication. Personnel are scarce, stigma is high and often persons with mental illness become separated from families and suffer premature death. This presentation will describe a simple paradigm initiated under the auspices of the WHO, which has now been utilized and evaluated in the past decade. It involves the use of supervised primary health care workers who provide education, vocational training, and titrated medication to identified patients living at home. The comparative results for the utilization of typical and atypical antipsychotic medication on relapse and need for hospitalization as well as side effects and morbidity and mortality will be presented.