Table 1 Facility-based care three-tier system for the treatment of mental illness
Location | Staff | Tasks | Referral |
|---|---|---|---|
Tier 1: primary care | |||
 Eight health centres across Sodo district | Health officers and nurses | • Prescribe antipsychotic medication (oral haloperidol or chlorpromazine) and monitor response • Manage side-effects • Monitor suicide risk • Review physical health • Screen for substance misuse • Provide basic psychoeducation (information about schizophrenia) • Provide regular follow-up | • Refer to tier 2 in the following scenarios:   o Active suicidal intent   o Inadequate oral intake of fluid or food   o Risk of violence to others and/or risk of serious self-neglect   o Persistently non-adherent to medication   o Acutely disturbed and not manageable at home   o Pregnancy/breastfeeding   o Medical complications   o Unmanageable side-effects |
Tier 2: general secondary care | |||
 Psychiatric outpatient clinic at Butajira Hospital | Psychiatric nurse | • Specialist review • Initiate depot injection where required | • Refer to tier 3 when inpatient care is required • Refer back to tier 1 for follow-up |
Tier 3: specialist care | |||
 Ammanuel Psychiatric Hospital, Addis Ababa | Psychiatrist | • Specialist review • Inpatient admission where required | • Refer back to tier 1 and/or tier 2 for follow-up |