Schizophrenia meets the four criteria for a problem requiring public health action:

1. The problem occurs frequently and widely.
2. The problem causes severe disability and suffering.
3. There are effective methods of dealing with the problem.
4. Treatments are acceptable to patients, their families, and society.

Schizophrenia occurs frequently and widely / A World Health Organization (WHO) study detected very little variation in the incidence of the illness in countries around the world. Using a precise definition of schizophrenia, it has been found that the incidence of schizophrenia is not significantly different between countries (7-14/100,000 in the sites investigated). When a less rigid definition is used, incidence figures are considerably higher, and when other psychotic conditions related to schizophrenia are included, the incidence rates are higher still and show significant variation across countries (Jablensky et al. 1992).

Schizophrenia causes severe disability and suffering / The discrimination because of schizophrenia increases the suffering associated with the disease for the patient. Those close to the patient suffer because they are also marked by the stigma of the disease. It has been estimated that in 1991, schizophrenia cost the United States $19 billion in direct expenditures and $46 billion in lost productivity (indirect costs), a total of almost $65 billion. When the indirect costs, which make up 71% of the total, are added to the direct costs, it is possible to obtain a more comprehensive estimate of the financial burden of this illness, which devastates the lives of millions of individuals and their families (Wyatt et al. 1995). Recent studies estimating the burden of schizophrenia indicate that the disease causes distress, loss of productivity, lower quality of life, and secondary mental health problems for patients and their families (Thornicroft and Tansella 1996).

Schizophrenia is treatable / A recent review found that, in approximately 20%–25% of people with schizophrenia all symptoms disappear, and that return to self-sufficiency and good social functioning occurs in a further 20% (Warner 1994). Reports from developing countries indicate much higher rates of recovery. Even if treatment does not remove all symptoms, effective treatment can increase an individual's quality of life and ability to function. Since the introduction of chlorpromazine in the 1950s, an increasing number of medications and psychosocial treatments have been developed that can effectively alleviate the symptoms of schizophrenia. These medications are particularly valuable in reducing or eliminating positive symptoms such as delusions, hallucinations, and agitation that occur in acute episodes of the illness. Many of the traditional antipsychotics cause side effects (e.g., rigidity, tremor) that can contribute to stigma. However, new antipsychotic medications are now available that cause significantly fewer motor side effects and have advantages over the traditional medications. These newer agents are sometimes also effective in helping patients for whom the previously available medications were not effective. Because these agents cause fewer side effects, they may improve adherence to treatment and reduce stigma associated with side effects. Psychosocial interventions, especially support for families and caregivers, have proved very effective in reducing relapse in schizophrenia (Anderson and Adams 1996; Schooler et al. 1997). Vocational interventions can also substantially increase the rate of employment of individuals with schizophrenia (Bond et al. 1997). Effective social support systems can also improve the outcome for individuals with schizophrenia (Brugha 1995).

The treatment for schizophrenia can be made acceptable / Although traditional antipsychotic medications are effective in removing symptoms, these medications can produce significant side effects. The novel antipsychotic agents appear to cause less serious side effects and are likely to be better tolerated by patients. The acceptability of treatment further increases when the patient and family receive education and support to help them cope with the illness and are allowed to become partners in treatment.
_______________________