- Design
- Prospective uncontrolled cohort study, 12 months
- Population
- 37 adults with severe mental illness in rural Türkiye (30 completed)
- Primary outcome
- Change in disability, clinical severity, psychopathology and risk scores
- Effect
- Sheehan disability −12.6 (95% CI −14.7 to −10.6); CGI-S −2.2 (−2.5 to −1.9)
This prospective uncontrolled cohort followed adults with severe mental illness in rural Türkiye in 2018 to 2019. After a joint home assessment, the family physician made quarterly mobile visits with a psychiatrist joining by live video. Of 37 enrolled, 30 completed 12 months; six moved to cities and one died of myocardial infarction.
Over 12 months, disability (Sheehan scale −12.6, 95% CI −14.7 to −10.6), clinical severity (CGI-S −2.2) and general psychopathology (PANSS general −29.9) all fell, as did scored risks of self-harm, harm to others and relapse.
The authors are clear that without a control group these are changes over time, not proof the model works. Still, the design, with the family physician as the constant and the psychiatrist brought in remotely, is directly relevant to rural India, where psychiatrists are scarce and the family doctor is often the only regular contact.
- A shared-care model with remote psychiatric input is feasible from a rural family practice.
- Home assessment at the start was part of the model; whether it helps engagement was not tested.
- Monitor physical health too: one participant with schizophrenia died of a heart attack.
- Tele-MANAS and district mental health programmes offer remote specialist support in India.
Why it matters
It sketches a workable model for severe mental illness care where the nearest psychiatrist is hours away.
Don't overread it
An uncontrolled cohort of 30 cannot establish effectiveness; the authors say so themselves.
The statistics, in plain English
Improvements measured before and after in the same people can reflect natural recovery, regression to the mean or other care, not only the intervention. With 30 completers, the results are fragile.
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