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What is the best approach to treating schizophrenia in developing countries?

Schizophrenia is relatively rare — affecting 1% of the world's population — but is arguably one of the most severe mental illnesses. Diagnosing and treating it can be hard enough in developed countries; the challenges are magnified in developing nations with inadequate health systems; few trained staff; and pervasive social stigma. So how best to treat it? In this debate, three psychiatrists offer their different viewpoints.

Vikram Patel, at the London School of Hygiene and Tropical Medicine, says the shortage of mental health specialists means that the most effective way of spreading the expertise around might be for non-specialist health workers or community representatives to be trained to bear the brunt of providing first-line mental health services. Saeed Farooq, at Pakistan's Lady Reading Hospital, argues that the principles of the WHO's DOTS TB programme, in which patients are given an uninterrupted supply of medication taken under close supervision, could be used to treat schizophrenia. The rationale is that missing medication for schizophrenia, which can be common given the cognitive impairment associated with the illness, has serious consequences and can lead to much higher risks of relapse. R. Thara, director of the Schizophrenia Research Foundation, Chennai, India, advocates tackling stigma by offering proper treatment. In India at least, he says, the mystification of mental illness is intensified by a lack of awareness about schizophrenia and also by "magico-religious" beliefs. Effective treatment that shows the symptoms to be an illness rather than a religious curse is the best antidote to stigma, he says.

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