The researchers tracked the patients’ symptoms and quality of life over 12 months. Both groups improved on measures of symptom severity over the course of the year. But those who received the community-based component — particularly in the most rural site, Tamil Nadu — did slightly better than the others. They were more likely to show sustained relief of symptoms like suspiciousness, withdrawal and delusions; to become more social and engaged at home; and to be working.

The role of community is particularly important for mental health interventions in remote areas. A village can effectively expel a program that offends its traditional conceptions of mental problems, just as it can expel a disruptive person with mental illness, experts say. But that same self-protective instinct can work to support new approaches if the community buys in.

A new study, funded by the Wellcome Trust, is testing this approach for people with schizophrenia in Ethiopia, delivering the entire package of interventions. “The key thing is that it’s not simply home-based care for people with schizophrenia,” Laura Asher, who is running the study, said by email. “It also involves awareness raising and community mobilization.”

Access to medication is essential, and psychiatric drugs are cheap by Western standards in places like Ethiopia: generally no more than $1 for a monthly supply of generic antipsychotic pills. But that almost always comes out of pocket, and many people cannot afford it, Dr. Asher said. Part of mobilizing the community, she said, is setting up informal arrangements in villages in which people with means contribute to help those who cannot afford care.

Drug supply is perhaps the largest obstacle to success. In Ghana, there are shortages almost every year, in part because of delays in the government contracting process, said Humphrey Kofie, the executive secretary of the Mental Health Society of Ghana, the country’s leading patient advocacy group. This drives up prices and feeds a black market for donated or subsidized drugs. Families, discouraged, fall back on traditional healers, Mr. Kofie and others said.

Still, the cost of these programs is minute compared with the cost of standard psychiatry. BasicNeeds Ghana, a mental health care program based in Tamale and similar to Mr. Akandem’s, spends about $8 per client per month on average, according to Peter Yaro, its executive director. In the United States, it costs $200 to $700 for a single appointment with a psychiatrist.

The Robert Wood Johnson Foundation has provided $280,000 through the Charities Aid Foundation of America for a trial of BasicNeeds’s model in underserved areas of the United States. “It’s part of a growing recognition that programs that are really effective in low-income countries, we can learn from them,” said Deborah Bae, a senior program officer at the foundation.