Supervised Treatment in OutPatients for Schizophrenia (STOPS+)

Background

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

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 treatment in a resource poor setting in Pakistan.

Project plan

Firstly to evaluate the effectiveness and implementation of STOPS+ in a primary health care setting in a resource poor setting in Pakistan.

Secondly to:

investigate the process and implementation outcomes for STOPS+ 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.
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.
assess the effectiveness of STOPS+ in reducing family burden, stigma in the community, and improving physical health in people with schizophrenia.
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.

Impact

The STOPS+ team worked closely with policymakers and clinicians from the outset of the project, which facilitated the acceptance and impact of the project. This included the Khyber Medical University (KMU) establishing an institute of mental health behavioural sciences as part of its NCD strategy. The institute has started training clinical psychologists and psychiatrists, and the training around treatment of severe mental illness is also included in the diploma of family medicine. At a national level, the team have successfully advocated for the inclusion of mental health care as integral part of national NCD strategy, and are working on an initiative to provide free drug treatment for severe mental illness as part of the government’s universal health coverage programme.

Publications and output

You may visit the project website for more information.

Principal investigators

Saeed Farooq Keele University, United Kingdom
Zia Ul Haq Khyber Medical University, Pakistan

Team members

Mian Mukhtar ul Hay Khyber Medical University, Pakistan
Atif Rahman Khyber Medical University, Pakistan
Martyn Lewis Keele University, United Kingdom
Muhammad Firaz Khan Khyber Medical University, Pakistan
Syed Irfan Ali Shah Khyber Medical University, Pakistan
Alyshah Abdul Sultan Khyber Medical University, Pakistan
Reuben Ogollah Khyber Medical University, Pakistan
Tom Shepherd Keele University, United Kingdom
Lisa Dikomitis Keele University, United Kingdom
Christian Mallen Keele University, United Kingdom
Krysia Dziedzic Keele University, United Kingdom