The community intervention program in Thirthahalli taluk, Shivamogga district (Community Intervention Psychotic Disorders, CoInPsyD) was started in June 2005 with research grants under the National Mental Health Program awarded to Dr. B N Gangadhar, Professor of Psychiatry, NIMHANS.

Since then, our team from NIMHANS and Dr. U Arunachala, a private psychiatrist practicing in Thirthahalli has been examining clinically relevant research questions among this representative, community-dwelling schizophrenia patients: these include, studies on course and outcome, disability, age at onset, metabolic syndrome, work functioning, family burden, substance use and tardive dyskinesia.

Needless to mention that, in addition to studying this cohort scientifically, the team has as well been providing regular clinical services to these underserved patients. Nearly 2/3rds of these patients were out-of-treatment and our team has provided services to them virtually at their doorsteps – while most receive follow up care in their nearest primary health centres, a substantial proportion of patients is seen in their houses. Where there is no government supply of medications, the team has provided medications such as olanzapine, clozapine etc., free of cost.

Though our research is focused on schizophrenia patients, for every patient with schizophrenia, the team has provided clinical services to four or five patients with various other disorders such as bipolar disorder, recurrent depressive disorders, alcohol use disorders, dysthymia, anxiety disorders, mental retardation, specific learning disabilities, etc., and neurological disorders like epilepsy, migraine, etc. Enhancing the community’s awareness about mental illnesses was an expected byproduct of our efforts. We have written newspaper articles on psychiatric disorders. Other community service activities that our team has engaged in Thirthahalli are to conduct a ‘disability’ camp and conducting interaction programs with community leaders in Thirthahalli focusing on the burden and disability caused by severe mental disorders and the role that communities could play in reducing these disabilities. During the camp, disability certificates were issued to 230 persons with mental retardation. A significant academic activity that the team accomplished was the state-level Continuing Medical Education (CME) program for psychiatry post-graduate students in Kavishaila of Thirthahalli Taluk in December 2010.

Additionally, to commemorate a decade of this work, in December 2015, a national conference was held in Thirthahalli, titled “Deliberations on Care Delivery (DECADE) for Mental Illnesses in Rural Communities”. Following topics were discussed: (a) 10 years experience of treating patients with severe mental disorders in their own communities (b) Challenges in reaching psychiatric care to patients: reflections on the National Mental Health Program (c) Role of Community Health Workers and how to harness them? (d) Challenging Neuropsychiatric cases in rural practice (e) managing alcohol use disorders at Primary Health Care Centers and (f) Relevance of Mental Health Care Bill 2013, on community treatment. Experts from all over the country actively participated in the deliberations.

For this work, our team has got excellent support from the department of health and family welfare and the taluk hospital of Thirthahalli. We have been able to manage funds from various sources to continue our service-cum-research activities thus far (i.e., from the National Mental Health Program’s research funds and grants from NIMHANS, including the team’s funds from pharmaceutical company supported clinical trials). These funds are used for the following purposes: travel, lodging and boarding for the research staff, salary support for the research staff, medication and in-patient admission costs for patients and other contingencies till date, 400 patients with schizophrenia have been identified. They are being treated and followed-up (around 12,000 follow-up visits). The number of patients with other disorders that the team has treated till now is about 4000 (totally 22,000 follow-ups till date). We have trained around 60 health workers in Thirthahalli taluk.  We have also been bearing the occasional inpatient admission charges for patients. Needless to say, this program has benefited patients and families immensely in terms of the easy access to psychiatric care and clinical benefits. From clinical, epidemiological and public health research points of view, this cohort is a unique one in the country, wherein the entire patient population of the taluk is accessible in their natural living environment. Consequently, the data that gets generated will not only be clinically meaningful, but also will have important public health and policy level implications.