Mental Health MH01, 2018 – 2022

Supervised Treatment in Out Patients for Scizophrenia (STOPS+)


The treatment gap in schizophrenia: Schizophrenia is ranked 13th for years lived with disability (YLDs) in the 15-49 years age group in developing countries, which represents a 60% increase in years lost since 1990 (Institute for Health Metrics and Evaluation, 2013). Despite this, around two third (69%) of patients in developing countries receive no treatment (Lora et al, 2012). The treatment gap (TG) is the absolute difference between the true prevalence of a disorder and the treated proportion of individuals affected by the disorder (Lora et al, 2012). Based on a systematic review of 37 studies, Kohn et al (2004) estimated the TG for schizophrenia to be 32%. A recent study using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) for assessment of service utilisation in 50 countries reported a median TG of 69%. The schizophrenia TG for Pakistan was at a staggering 96%

Aims and Objectives

We aim to assess the effectiveness and cost effectiveness, and implementation of STOPS+ versus Enhanced Treatment As Usual (ETAU) in improving the treatment adherence and access to the treatment in the community. Primary objective: The primary objective of the study is to evaluate the effectiveness and implementation of STOP+ in a primary health care setting in a resource poor setting in Pakistan. * Secondary objectives*  To investigate the process and implementation outcomes for STOP+ in the community by estimating the cost effectiveness, assessing the impact of STOPS+ implementation in the whole health system and acceptability of STOPS+ for all stakeholders  To evaluate the effectiveness of STOPS+ compared to Enhanced Treatment As Usual (ETAU) in reducing the treatment gap by increasing medication adherence, improving the access to medication and mental health treatment in primary care.  To assess the effectiveness of STOPS+ in reducing family burden, stigma in the community, and improving physical health in people with schizophrenia.  To investigate the acceptability of STOPS+ for service users and health care providers, and assess the effects of the implementation of STOPS+ on the wider health system.

Dr Saeed Farooq
Dr. Zia Ul Haq
Professor Mian Mukhtar ul Hay
Professor Atif Rahman
Dr Martyn Lewis
Dr. Muhammad Firaz Khan
Dr Syed Irfan Ali Shah
Dr Alyshah Abdul Sultan
Dr Reuben Ogollah
Dr Tom Shepherd

  • Mental Health MH01
  • Pakistan
  • 2018 – 2022