Publications
This archive brings together publications and outputs emerging from PIECEs — a five-year NIHR-funded research programme improving community-based mental health care in India and Pakistan.
Together, they reflect the connected programme of research across both countries, and present outputs in a range of formats, including journal articles, statistical analysis plans, toolkits and reports, organised by year and by type of publication. Individually and collectively, these works generate insights that aim to inform further research, spark discussion, and contribute to policy development.
Statistical Plan
PIECEs RCT Statistical Analysis Plan (SAP)
The PIECEs Statistical Analysis Plan (SAP) sets out how data from the cluster-randomised controlled trial of DIALOG+ for people with psychosis in India and Pakistan will be analysed. The primary objective is to determine whether DIALOG+ improves participants’ quality of life at six months, measured using the MANSA, with additional outcomes at 6 and 12 months covering psychiatric symptoms, social functioning, disability, therapeutic relationships, health/service use and caregiver burden. The main analysis follows an intention-to-treat approach, using mixed-effects linear regression to compare DIALOG+ with the control condition while accounting for clinician clustering and baseline MANSA scores; missing data are addressed through multiple imputation, alongside sensitivity analyses.
Year
2021
Statistical Plan
Health Economics Analysis Plan (HEAP) – PIECEs Trial
The Health Economics Analysis Plan (HEAP) sets out the approach for assessing the cost-effectiveness of DIALOG+ as part of the PIECEs randomised controlled trial in India and Pakistan. It describes how the economic evaluation will examine costs to healthcare providers, patients and families alongside changes in quality of life, including Quality Adjusted Life Years (QALYs).
The plan outlines the methods for collecting, managing and analysing economic data across the PIECEs trial sites, including healthcare resource use, patient and caregiver costs, and intervention costs. The evaluation is designed to provide country-specific evidence for India and Pakistan, alongside a pooled analysis examining the potential cost-effectiveness of DIALOG+ in resource-constrained settings.
Year
2021
Toolkit
Voices in Practice: A Guide for Participatory Mental Health Research and Stakeholder Engagement in South Asia
Voices in Practice grew directly from the experiences, learning and challenges of the PIECEs research programme, a four-year initiative working across India and Pakistan to improve community-based care for people living with psychosis. The programme was led by Queen Mary University of London (UK), the Schizophrenia Research Foundation (SCARF) in Chennai, India, and Interactive Research and Development (IRD) in Karachi, Pakistan, working alongside people with lived experience, caregivers, researchers, artists, healthcare professionals and community partners.
Throughout PIECEs, people with lived experience were increasingly involved not simply as research participants, but as co-creators, knowledge-holders and agents of change, helping to shape the design, delivery and dissemination of the research.
The guide brings together practical lessons from the participatory approaches developed and tested through PIECEs, including Lived Experience Advisory Panels (LEAPs), Theatre of the Oppressed, SALT and the Community Life Competence Process, Quality Improvement, and small-scale research grants. It translates this collective experience into practical guidance for researchers, community organisations, facilitators, healthcare professionals and institutions seeking to embed lived experience, meaningful participation and community engagement within mental health research and services in South Asia and beyond.
Throughout PIECEs, people with lived experience were increasingly involved not simply as research participants, but as co-creators, knowledge-holders and agents of change, helping to shape the design, delivery and dissemination of the research.
The guide brings together practical lessons from the participatory approaches developed and tested through PIECEs, including Lived Experience Advisory Panels (LEAPs), Theatre of the Oppressed, SALT and the Community Life Competence Process, Quality Improvement, and small-scale research grants. It translates this collective experience into practical guidance for researchers, community organisations, facilitators, healthcare professionals and institutions seeking to embed lived experience, meaningful participation and community engagement within mental health research and services in South Asia and beyond.
Year
2026
Toolkit
A Guide to Developing an Advisory Board for People with Early Psychosis
The ADEPT Manual is a practical guide for developing and running advisory boards for people experiencing early or first-episode psychosis. Co-developed with people with lived experience, caregivers, mental health professionals and community stakeholders, it promotes meaningful participation in the planning, delivery and evaluation of mental health services and research.
Developed by the Schizophrenia Research Foundation (SCARF) in India, the guide provides practical guidance on establishing an advisory board, including defining its goals, recruiting and supporting members, orientation and training, structuring meetings and improving the board over time. It was developed through the PIECEs Small Scale Research Grant programme, funded by NIHR.
Developed by the Schizophrenia Research Foundation (SCARF) in India, the guide provides practical guidance on establishing an advisory board, including defining its goals, recruiting and supporting members, orientation and training, structuring meetings and improving the board over time. It was developed through the PIECEs Small Scale Research Grant programme, funded by NIHR.
Year
2025
Journal Article
Implementing psychosocial interventions within low and middle-income countries to improve community-based care for people with psychosis—A situation analysis
This PIECEs situation analysis examined existing psychosocial care for people with psychosis in India and Pakistan and assessed readiness to introduce new interventions such as DIALOG+. It found strong interest in psychosocial and multidisciplinary approaches, but identified major implementation barriers including limited clinician time, staff attitudes, high workloads and inadequate physical space, highlighting the importance of adapting interventions to local health-system realities.
Year
2022
Journal Article
PIECEs: RCT Findings paper
COMING SOON
Year
2026
Journal Article
Helping people with psychosis with a low-cost intervention DIALOG+: protocol for the economic evaluation in a randomised control trial in India and Pakistan
This PIECEs economic evaluation protocol describes how the study will assess the cost-effectiveness of DIALOG+ for people with psychosis in India and Pakistan alongside the randomised controlled trial. It uses a cost-utility analysis, with quality-adjusted life years (QALYs) as the primary outcome, to determine whether DIALOG+ can provide an affordable and scalable approach to improving community-based psychosis care in resource-constrained settings.
Year
2025
Journal Article
Assessing the effectiveness and cost-effectiveness of a solution-focused resource-orientated approach (DIALOG+) to improving the quality of life for people with psychosis in India and Pakistan—a cluster RCT
This PIECEs study protocol describes the cluster randomised controlled trial designed to test the effectiveness and cost-effectiveness of DIALOG+ for people with long-term psychosis in India and Pakistan. The trial compares DIALOG+ with an active control, focusing primarily on whether the intervention improves quality of life at six months, while also assessing clinical and social outcomes, costs, and the experiences and acceptability of DIALOG+ in routine mental health services.
Year
2023
Journal Article
PIECES- Pilot Feasibility Study: Exploring the feasibility and acceptability of DIALOG+ (a structured digital communication tool) in strengthening psychiatric care in India and Pakistan: a qualitative pilot study
This paper explored the feasibility and acceptability of DIALOG+ for people with psychosis in India and Pakistan. Patients and clinicians valued its structured, person-centred approach and broader discussion of quality of life, but implementation was challenged by clinician workload and busy outpatient services. The study highlights the importance of institutional support, adequate resources and culturally appropriate adaptations, including consideration of caregiver involvement.
Year
2025
Journal Article
SSRG: Of the people, for the people, by the people: Development of an ADvisory board for Experience-enriched service and research in Psychosis Treatment – ADEPT Project
The study developed and piloted an inclusive advisory board for first-episode psychosis services in India, bringing together people with lived experience, caregivers and professionals. It demonstrated that structured training, attention to power dynamics and diverse participation can meaningfully integrate lived-experience perspectives into mental health research and services.
Year
2025
Report
PIECEs' Smal Scale Research Grants in India and Pakistan - Report
The PIECEs Small-Scale Research Grants (SSRG) programme supported ten community-led mental health projects across India and Pakistan, demonstrating how small grants can strengthen local research capacity while generating meaningful, culturally relevant impact. The programme highlighted the value of participatory approaches, lived experience, local partnerships and creative methods, while identifying sustainability and access to services as key challenges.
Year
2025
Book Chapter
Chapter in Handbook of Health Communication in the Global South
Year
2026
Book Chapter
Chapter: Moving beyond the checklist: Practitioners' insight on lived experience collaboration in mental health research from India and Pakistan
COMING SOON
Year
2026
Book Chapter
Chapter 27 in Handbook of Health Communication in the Global South: Transformative Participatory Research Methodologies in Mental Health Research - Insights from South Asia
This chapter examines transformative participatory research in mental health in India and Pakistan, drawing on the PIECEs programme. It shows how arts-based methods, Lived Experience Advisory Panels (LEAPs), stakeholder engagement and quality-improvement approaches can place people with lived experience, families and communities at the centre of research and service development, helping address stigma and power inequalities while supporting more culturally relevant and sustainable mental health systems.
Year
2026
Documentary Film
Voices Unheard
A documentary that rethinks the narrative around psychosis, through the voices of those who live it.
Filmed between Chennai (India) and Karachi (Pakistan), Voices Unheard follows four people living with psychosis as they navigate family life, work, relationships, and everyday challenges. Through intimate, first-person storytelling, the documentary offers a rare and deeply human perspective on recovery, resilience, and belonging, inviting audiences to reconsider what they think they know about severe mental illness.
The film was created as part of PIECEs, an international research programme exploring new approaches to community-based care for people living with psychosis in India and Pakistan. Grounded in the belief that people with lived experience are experts in their own lives, the project brought together participants, family members, researchers, artists, and mental health professionals through community-based interventions and creative participatory methods, including Theatre of the Oppressed, to challenge stigma and imagine new possibilities for care and inclusion.
Produced by: Schizophrenia Research Foundation (SCARF, India), Interactive Research & Development (IRD, Pakistan), Queen Mary University of London, and People's Palace Projects.
Filmed between Chennai (India) and Karachi (Pakistan), Voices Unheard follows four people living with psychosis as they navigate family life, work, relationships, and everyday challenges. Through intimate, first-person storytelling, the documentary offers a rare and deeply human perspective on recovery, resilience, and belonging, inviting audiences to reconsider what they think they know about severe mental illness.
The film was created as part of PIECEs, an international research programme exploring new approaches to community-based care for people living with psychosis in India and Pakistan. Grounded in the belief that people with lived experience are experts in their own lives, the project brought together participants, family members, researchers, artists, and mental health professionals through community-based interventions and creative participatory methods, including Theatre of the Oppressed, to challenge stigma and imagine new possibilities for care and inclusion.
Produced by: Schizophrenia Research Foundation (SCARF, India), Interactive Research & Development (IRD, Pakistan), Queen Mary University of London, and People's Palace Projects.
Year
2026