Community Engagement
PIECEs took several different approaches to community engagement throughout the project. What began as a single work package took on a life of its own, growing far beyond our original expectations, and leaving a lasting impact on both researchers and the wider community.
At the centre of this work was India and Pakistan’s first Lived Experience Advisory Panel (LEAP) network, which grew to nine members in India and ten in Pakistan. LEAP ensured that lived experience informed every stage of the research, from shaping the questions we asked to reviewing our findings.
Out of this network grew two community theatre troupes, made up entirely of people with lived experience of severe mental health illness. Trained by some of the world’s most renowned Theatre of the Oppressed experts, six members in India and eight in Pakistan learned to use these methods to spark dialogue and challenge stigma in front of live audiences – in schools, community centres, healthcare settings, corporate offices and beyond.
The reach of that work grew steadily over the course of the project:
40 performances
for the general public, reaching an audience of 2,201 people
78 performances
in healthcare settings — including “waiting-room theatre” at psychiatric facilities — drawing 2,979 viewers
9 performances
in educational institutions, including sessions with medical students, reaching 756 participants
12 workplace events,
engaging 820 employees across corporate and industry settings
7 external dissemination events
experienced by 620 attendees
Alongside the theatre work, PIECEs also drew on two further approaches to community engagement: SALT, a method for sparking community-led reflection and change, and Quality Improvement (QI) workshops, which brought clinicians into the process of strengthening services around DIALOG+.
This page brings together the five strands of that work: the participatory arts programme, the Lived Experience Advisory Panel, Namma Area — an informal hangout space for mental health service users in Chennai — and the SALT and Quality Improvement workshops.
The reach of that work grew steadily over the course of the project:
Theatre of the Oppressed
What is Theatre of the Oppressed?
At the centre of this work was India and Pakistan’s first Lived Experience Advisory Panel (LEAP) network, which grew to nine members in India and ten in Pakistan. LEAP ensured that lived experience informed every stage of the research, from shaping the questions we asked to reviewing our findings.
Out of this network grew two community theatre troupes, made up entirely of people with lived experience of severe mental health illness. Trained by some of the world’s most renowned Theatre of the Oppressed experts, six members in India and eight in Pakistan learned to use these methods to spark dialogue and challenge stigma in front of live audiences – in schools, community centres, healthcare settings, corporate offices and beyond.
Useful links and references
LEAP
The Lived Experience Advisory Panel (LEAP) is an expert resource for the research team and support to steer the project.
It brings people with lived experience of severe mental health illnesses, and carers, to help as a critical panel supporting the decisions, adaptations and evaluations made in the whole process of the research.
The LEAP experience has been a common practice in the UK for many years, but was a completely new and novel concept in clinical work in India and Pakistan. Both countries set up local LEAP groups, formed of people who have recent and relevant lived experience of mental health challenges, carers of people who have recent and relevant experience of mental health challenges, and clinicians/facility staff who also share these lived experiences.
What does the LEAP do?
The LEAP provides ongoing feedback to improve the relevance, practicality, and influence of the research. This is done by:
Drawing on their own experience of and local knowledge about the study sites to advise and steer the researchers.
Advising on and assisting in recruitment and participation of people who use local services or participate in the research.
Making a contribution to any events at the study sites.
Resources on LEAP
Namma Area
An innovative hangout space for mental health service users at SCARF
Namma Area — which means “Our Space” in Tamil — is a hangout space in Chennai for people being treated for mental illness. It was launched in May 2022 to mark World Schizophrenia Day, with SCARF, Professor Paul Heritage (Queen Mary University of London and People’s Palace Projects), Arts Project Manager Mariana Steffen, and Programme Manager Renata Peppl who were all part of the opening.
The space runs twice a week — Tuesdays and Thursdays, 2pm to 6pm — on SCARF’s premises, and the idea behind it is simple: give people a place they can shape for themselves, with a genuine sense of autonomy and ownership, rather than a clinical setting they’re simply attending.
It started small, with board games like chess and carrom, and grew from there based entirely on what users asked for — a bike exercise machine, indoor plants, music, and books and magazines in Tamil. Regulars meet monthly to review how the space is being used and decide what comes next.
What began as curiosity for many first-time visitors has, for a number of regular users, grown into real comfort — both with the space and with each other. It’s a quiet example of what community engagement can look like when the people using a service also get to help run it.
SALT (Stimulate, Appreciate, Learn and Transfer)
Sparking community-led change
“I still feel there is leftover potential in me that needs to be discovered. I have realised that I’m not the only one with problems.”
— Male service user, Pakistan
Alongside the theatre programme, PIECEs used a method called SALT — standing for Stimulate, Appreciate, Learn and Transfer — to help communities reflect on their own strengths, recognise progress, and share what they’d learned with each other. SALT is used widely in community development and health work around the world, and its starting point is simple: build on what a community already has, rather than starting from what it lacks.
In PIECEs, SALT gave people with lived experience and their wider communities a structured way to push for change themselves, both within healthcare settings and, further down the line, at a policy level. Interactive workshops and community visits in Chennai and Karachi opened up conversations about severe mental illness that don’t happen easily elsewhere. Out of these sessions grew a network of service users, supported by the research team but driven by their own sense of what they could achieve together, mapping out what an ideal mental healthcare system would look like, and what it would take to get there.
Some of the ideas that came out of this work have real staying power. In Chennai, service users at SCARF set up a service-user-led canteen, designed to bring service users, caregivers and healthcare professionals into everyday contact with each other. Another group of service users in India used these workshops to develop plans for a service-user-led podcast, aimed at chipping away at stigma from the inside.
Reflections from the SALT-CLCP Knowledge Fair
In January 2025, the PIECEs India team and SCARF service users hosted a SALT-CLCP Knowledge Fair in Chennai, bringing together their own experience of the method with that of Avani, an Indian non-profit working with vulnerable children, women and communities in Maharashtra. It was a chance to compare notes on what SALT had achieved in two very different settings, and to think about how to do it better.
Quality Improvement (QI)
Bringing clinicians into the process
Quality Improvement, or QI, is a well-established way of working in healthcare across the UK and Europe, but one that’s still relatively rare in the Global South. It brings staff together in structured workshops to identify what isn’t working, learn practical improvement tools, and build their own plans to fix it, putting the people delivering care in the driving seat of how that care gets better.
PIECEs ran QI workshops in both public and private health facilities in Karachi and Chennai, with a clear focus: supporting the wider rollout of DIALOG+. The workshops gave healthcare providers and other stakeholders a shared space to name the problems getting in the way- limited infrastructure, communication gaps between patients and clinicians, and stretched human resources – and work through them together.
It wasn’t always a smooth process. QI as a methodology was unfamiliar to many facilities and professionals in South Asia, and that unfamiliarity showed up as understandable resistance and a slower-than-expected pace of adoption. Even so, the workshops helped build a habit of continuous improvement that’s still paying off, making mental health care more responsive to the people it’s meant to serve, including people with lived experience.
Scaling up DIALOG+ in Karachi
Between May and September 2024, the PIECEs Pakistan team ran a series of QI training workshops with 14 participants from four Karachi hospitals — one public and three private: Karwan-e-Hayat, Jinnah Postgraduate Medical Centre, Lady Dufferin Hospital, and Karachi Psychiatric Hospital.
Across five three-hour sessions, participants were introduced to core QI tools — the ELFT sequence and the Model for Improvement — and used techniques like the “5 Whys” and Fishbone diagrams to dig into the root causes of the problems they were seeing. From there, seven small groups each built their own QI project, setting a SMART aim and pulling together a stakeholder team at their own facility to keep the project moving through fortnightly check-ins.
The projects that came out of this work were genuinely practical: four focused on improving job satisfaction among healthcare staff and students by using DIALOG+ itself to surface and address workplace stressors, two focused on improving mental health outcomes for patients and caregivers, and one focused specifically on cutting down counselling time during follow-ups in busy, high-volume clinics.