- Use a holistic approach, including social, livelihood, health, education and empowerment
- Work with the family and the community
- Encourage respect for human rights
- Link to existing services where possible
- Use a recovery oriented approach emphasising hope
Overview of CBR intervention
1. Family-based components
There are three intervention phases, which reflect the changing needs of participants over 12 months
- Phase 1: Engagement (2 months)
- Phase 2: Stabilisation (3 to 7 months)
- Phase 3: Maintenance (8 to 12 months)
In Phase 1 all participants receive the following core modules, which reflect the core needs of most people with schizophrenia in this setting:
- Understanding schizophrenia
- Accessing health services
- Preparing for a crisis
- Dealing with Human Rights issues
At the beginning of Phase 2 and Phase 3, a detailed needs assessment is conducted. Structured goal setting is used to select appropriate goals for individuals from a pre-defined list. The goal selection determines which additional CBR modules the individual receives, from the following:
- Supporting individuals to take medication
- Improving physical health
- Improving day to day functioning
- Getting back to work
- Dealing with stress and anger
- Improving literacy
- Dealing with stigma and discrimination
- Taking part in community life
- Improving the family environment
- Taking control of your illness (relapse prevention)
The transition between phases is conditional on achievement of goals rather than specific time points.
2. Community mobilisation
Community mobilisation work runs alongside family-based components. It consists of:
- Resource mapping
- Community awareness raising
- Engaging with community leaders and facilitating access to existing community resources
- Identifying and linking participants to employment opportunities
3. Family support groups
Caregivers are invited to join family support groups. The groups offer mutual emotional support.
CBR workers have a minimum of 10 years of formal education and are from the local area. They have no previous experience in mental health work. CBR workers received 5 weeks training, covering theoretical and practical aspects of CBR for schizophrenia.
CBR was delivered to participants and their caregivers at their home by a specialist CBR worker and included psychoeducation, adherence support, rehabilitation (including self-care and social skills), and family support groups. The intervention also included education and mobilisation of community leaders.
The comparison condition in this study was facility-based care (FBC), which comprised anti-psychotic medication prescribed by a nurse or clinical officer in a health centre and basic psycho-education, delivered as part of the PRIME mental health care plan.