Delivery by “trained hospital-based health workers” of “family psychoeducation package” to caregivers of patients with schizophrenia through “task-sharing” strategy

Abstract

Background: In India, there is an urgent need to evaluate cost-effective methods providing basic awareness on mental illness. Family psychoeducation (FP) for caregivers of patients with severe mental illnesses (SMIs) is one such important intervention. Due to high treatment gap, concepts of “scaling up” and “task sharing” have been advocated; evidence is available through the use of “community lay workers.” However, there is no evidence for the delivery of FP by lay persons in a hospital setting. Objectives: The study had the following objectives, namely (i) to compare the effectiveness of delivery of “FP package” (FPP) to caregivers of persons with schizophrenia using different professionals versus hospital-based health workers (HHWs) and (ii) to see whether FPP brought any change in the level of knowledge, burden, needs, and effect for the caregivers. Methodology: The study was conducted at the Disability Assessment Rehabilitation and Triage Services, Mental Health Institute, Government Medical College Hospital 32, Chandigarh, using the “Service Evaluation Framework.” Twenty-two caregivers of patients with SMI, attending the Family Intervention Services, were divided into three groups and provided FPP (NIMHANS Manual) by pair of psychiatrists, psychiatric social workers (PSWs), and trained HHW, respectively. The three groups were assessed using Assessment Questionnaire (AQ) and then compared across and pre–post intervention as per identified objectives. Results: All the three groups were comparable across relevant socioclinical variables. At baseline, all three groups were comparable on the AQ; post-FPP delivery, they remained comparable. In addition, FPP, as an intervention, did not improve the level of knowledge, burden, needs, and effect for the caregivers in any of the three groups. Conclusions: HHWs, after receiving appropriate and adequate supervision, are able to deliver FPP using “The Manual” as effectively as other mental health professionals (psychiatrists, PSWs). However, this is not able to bring about effective change in the level of knowledge. Nevertheless, this adds to the evidence base of use of “lay workers,” “task-sharing strategy,” and “scaling-up approach” from low- and middle-income countries such as India.