Research
Approximately 5-8% of the world’s population suffer from a Severe Mental Illness (SMI) presenting a major challenge worldwide. SMI causes significant distress to affected people, families and wider communities, generating high costs through loss of productivity and ongoing healthcare use. The burden is greatest in low- and middle-income countries (LMICs), where there may be a lack of financial resources and qualified staff to provide extensive specialised services. Within LMICs, an estimated 69%-89% of people with SMI experience a treatment gap, adding to other significant social inequalities. This treatment gap is most pronounced for people with psychosis, particularly chronic psychosis, where 75% of all individuals fail to receive adequate care, despite a high financial burden and reduced quality of life (QoL).
PIECEs focuses on two LMICs:
India and Pakistan.
Lack of mental health services and widespread poverty means that mental health issues often remain undiagnosed, misdiagnosed, or untreated within both countries. In India, the estimated lifetime prevalence of mental disorders is 13.9%, with inadequate infrastructure, financial and human resources resulting in a ratio of 3 psychiatrists per million people. The treatment gap is calculated at 70-75% for patients with psychosis. The prevalence of mental health disorders in Pakistan is reportedly up to 34%, and inadequate attention to mental health in the public sector has resulted in an estimated ratio of 2-3 psychiatrists per million people.
Source: Who.Int
Approximately 5-8% of the world’s population suffer from a Severe Mental Illness (SMI) presenting a major challenge worldwide. SMI causes significant distress to affected people, families and wider communities, generating high costs through loss of productivity and ongoing healthcare use. The burden is greatest in low- and middle-income countries (LMICs), where there may be a lack of financial resources and qualified staff to provide extensive specialised services. Within LMICs, an estimated 69%-89% of people with SMI experience a treatment gap, adding to other significant social inequalities. This treatment gap is most pronounced for people with psychosis, particularly chronic psychosis, where 75% of all individuals fail to receive adequate care, despite a high financial burden and reduced quality of life (QoL).
PIECEs focuses on two LMICs:
India and Pakistan.
Lack of mental health services and widespread poverty means that mental health issues often remain undiagnosed, misdiagnosed, or untreated within both countries. In India, the estimated lifetime prevalence of mental disorders is 13.9%, with inadequate infrastructure, financial and human resources resulting in a ratio of 3 psychiatrists per million people. The treatment gap is calculated at 70-75% for patients with psychosis. The prevalence of mental health disorders in Pakistan is reportedly up to 34%, and inadequate attention to mental health in the public sector has resulted in an estimated ratio of 2-3 psychiatrists per million people.
Source: Who.Int
Care for people with psychosis in India and Pakistan exists almost exclusively in their home. Families play a critical role in the caregiving process. Lack of qualified staff limits the ability to provide services used in high-income countries (HICs) such as multi-disciplinary teams or specialised psychological treatments (e.g., Cognitive Behavioural Therapy). LMICs therefore need effective, appropriate and low-cost forms of care that utilise and strengthen existing personal and social resources available to individuals, their families and communities. Where investment has occurred, it has often focused on the detection of SMI, and/or on early intervention. Such approaches are promising, but less resource and research is allocated to those with chronic psychosis, where community-based interventions are severely limited. Reducing the treatment gap for individuals with psychosis by providing low-cost, effective interventions is an urgent priority.
Care for people with psychosis in India and Pakistan exists almost exclusively in their home. Families play a critical role in the caregiving process. Lack of qualified staff limits the ability to provide services used in high-income countries (HICs) such as multi-disciplinary teams or specialised psychological treatments (e.g., Cognitive Behavioural Therapy). LMICs therefore need effective, appropriate and low-cost forms of care that utilise and strengthen existing personal and social resources available to individuals, their families and communities. Where investment has occurred, it has often focused on the detection of SMI, and/or on early intervention. Such approaches are promising, but less resource and research is allocated to those with chronic psychosis, where community-based interventions are severely limited. Reducing the treatment gap for individuals with psychosis by providing low-cost, effective interventions is an urgent priority.
Our research programme will explore, adapt and test a low-cost, generic approach (DIALOG+) that makes use of existing resources to improve community-based care for patients with psychosis and reduce the need for institutionalisation.
DIALOG+ is an app-mediated intervention that has been shown to improve mental health outcomes. During each meeting with their clinician, patients begin by rating their life and treatment satisfaction and state whether they need additional help in each area. As DIALOG+ is an app-based intervention, the results are stored and can be compared with previous ratings. Finally, the intervention helps clinicians provide solutions for concerns raised by the patient. Although this intervention has been shown to be effective within high income countries such as the UK, it requires cultural adaptation and validation within India and Pakistan in order for it to be implemented as part of routine care.
Our research programme will explore, adapt and test a low-cost, generic approach (DIALOG+) that makes use of existing resources to improve community-based care for patients with psychosis and reduce the need for institutionalisation.
DIALOG+ is an app-mediated intervention that has been shown to improve mental health outcomes. During each meeting with their clinician, patients begin by rating their life and treatment satisfaction and state whether they need additional help in each area. As DIALOG+ is an app-based intervention, the results are stored and can be compared with previous ratings. Finally, the intervention helps clinicians provide solutions for concerns raised by the patient. Although this intervention has been shown to be effective within high income countries such as the UK, it requires cultural adaptation and validation within India and Pakistan in order for it to be implemented as part of routine care.
Work Packages
The programme of research includes five work packages in order to develop, test and implement DIALOG+
Use of mixed methods (interactive workshop, focus groups and small-scale pilot) to adapt DIALOG+ to ensure it is culturally appropriate before it is tasted in a cluster randomised controlled trial (RCT) in.
Randomised Controlled Trial on one site in India and two sites in Pakistan.
Qualitative process evaluation will identify barriers and facilitators to implementation, to be used alongside quality improvement and SALT community engagement workshop.
Programme to enhance service and research-capacity by developing a critical mass of skilled individual to sustain research activities.
Use of different arts-based methods (participatory arts methods including Theatre of the Oppressed) to interact with local communities, give voice to people with psychosis through setting up a Lived Experience Advisory Panel (LEAP), and promote new understandings for researchers and service users.
Work Packages
The programme of research includes five work packages in order to develop, test and implement DIALOG+
Use of mixed methods (interactive workshop, focus groups and small-scale pilot) to adapt DIALOG+ to ensure it is culturally appropriate before it is tasted in a cluster randomised controlled trial (RCT) in.
Randomised Controlled Trial on one site in India and two Sites in Pakistan.
Qualitative process evalutation will identify barries and facilitators to implementation, to be used alongside Quality improvement and SALT community engagement workshop.
Programme to enhance service and research-capacity by developing a critical mass of skilled individual to sustain research activities.
Use of different arts-based methods (participatory arts methods including Theatre of the Oppressed) to interact with local communities, give voice to people with psychosis through setting up a Lived Experience Advisory Panel (LEAP), and promote new understandings for researchers and service users.