Background. A significant number of patients with severe psychiatric disorders remain untreated in the community although health services are available. The factors related to non-treatment are not well understood.

Method. A door-to-door survey was conducted on an Indian urban population of 100 000 using standardized screening and clinical instruments as a part of a larger epidemiological study. Treatment status was determined from multiple sources of information.

Results. Nearly one-third of 261 schizophrenia patients were found never to have received treatment. They were older in age and ill for a longer duration than those who had been treated and were more symptomatic and severely disabled. They were more often uneducated and divorced and lived with larger extended/joint families. This last factor was considered as being the important factor in determining whether the patient received treatment.

Conclusion. The larger extended/joint family, which was able to compensate and cope with the dysfunctional member, seemed to be the crucial factor related to non-treatment of the schizophrenic patient.