Psychosocial Rehabilitation and peer support for people with schIZophrEnia in South Africa (PRIZE): a pilot cluster-randomised trial

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Schizophrenia is a mental illness that can lead to problems in family life and in keeping a job. Experts agree that a combination of medication and psychosocial rehabilitation (PSR) gives people with schizophrenia the best chance of recovery. PSR involves a support worker giving information, advice and support on topics such as understanding schizophrenia, taking medication, getting back to work and building relationships. Whilst the South African government supports this approach, in reality such programmes are rarely implemented because of a shortage of mental health professionals in South Africa. In a previous project, we developed group-based PSR for South Africa delivered by auxiliary social workers, who are not mental health specialists. Having non-specialists deliver the programme makes it more feasible to deliver widely, to reach the people with schizophrenia who need this support across the country. The people with schizophrenia who received PSR felt it was beneficial, but their family members were difficult to engage with and there was no ongoing support in place once the 4 month PSR programme had finished. We also found that we don't have accurate ways of measuring disability, unmet needs and recovery in people with schizophrenia in South Africa. This project aims to improve on the previous PSR programme by finding better ways to involve caregivers and by adding a peer support component. Peer support groups involve service users sharing their experiences and jointly solving problems. Groups are led by service users on a voluntary basis. Peer support groups are a promising way to provide long-term psychosocial support in the community. It is hoped this new combined PSR and peer support programme could be implemented across South Africa and that it will be beneficial for service users. We will use the information from this study to plan a future larger study, which will give us better information on whether PSR and peer support works to improve outcomes of people with schizophrenia and whether it provides value for money.The current study will last three years and is set in Nelson Mandela Bay District, Eastern Cape, South Africa. There are four objectives.Objective 1 is to develop a combined PSR and peer support programme for people with schizophrenia that is suitable for the setting and addresses the problems in the previous PSR programme, including the lack of on-going support. We will achieve Objective 1 by seeking the views of service users, caregivers, and health workers in participatory workshops and in-depth interviews and using the findings to design a new programme.Objective 2 is to compare the combined PSR and peer support programme to stand-alone PSR in terms of how useful they are thought to be, and how practical they will be to implement into existing health services. We will achieve Objective 2 by conducting a pilot study involving 100 service users with schizophrenia in 10 clinics. We will randomly allocate 5 of these clinics to receive PSR and peer support, whilst 5 clinics will receive only PSR. After 4 and 10 months we will ask service users their views on the services and assess whether their needs are being met.Objective 3 is to improve assessments, in the form of short interviews, to more accurately measure disability, unmet needs and recovery. We hope these assessments can be used in future evaluations of PSR and peer support groups. We will achieve Objective 3 by holding focus groups with service users and caregivers to understand how well the assessments capture their problems. We will then test the assessments to check they are easy to understand and use.Objective 4 is to determine how practical it is to conduct a larger study of PSR and peer support in the future, and how many participants we would need to make the study worthwhile. We will achieve Objective 4 by testing various procedures, such as recruitment of participants, in the pilot study.