In Bosnia, Colombia, and Uganda, researchers are training local nurses, social workers, and family members to deliver talking therapies and social support to people with severe mental illnesses who currently receive little or no community care. Most mental health services in low- and middle-income countries are underfunded and hospital-based, leaving people with conditions such as schizophrenia or bipolar disorder without ongoing psychosocial support after discharge. This project addresses that gap by adapting three low-cost, evidence-based interventions—an app-guided communication tool called DIALOG+, one-to-one befriending, and family support—for use by non-specialist staff and volunteers in community settings. If the randomised controlled trials now underway show positive results, the interventions could be scaled through existing primary care and community networks, offering a practical route to expand mental health coverage without requiring large numbers of psychiatrists. The research is not fundamental science; it is a direct test of whether resource-oriented, locally adapted psychosocial care can work in real-world health systems. Success would give governments in the partner countries a replicable model for shifting mental health care from hospitals into communities.
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INSTITUTION A defining aim of QMUL’s strategy is the ‘the achievement of an international stature in knowledge creation and knowledge dissemination’ and a core objective is ‘furthering major collaborative research with overseas institutions’. Accordingly, QMUL has strongly supported the development of the Unit for Social and Community Psychiatry and its international activities. In 2012, the Unit was designated as a WHO Collaborating Centre, the only one specifically for Mental Health Service Development in the world. QMUL has promoted multi-disciplinary research on health care innovation through establishing the Life Sciences Initiative. In the REF 2014, the applying group was rated within UoA 2 (public health) among the top 5 in the country. The core of the research group is based at the Unit for Social and Community Psychiatry, which has 30 full time researchers. The involved Centres of Psychiatry and of Public Health and Primary Care bring a further 140 research and teaching staff. QMUL will provide all infrastructural support. As own contribution, QMUL will fund the work of the members of the group (Priebe 20%; Eldridge, Bhui, Patel, McCoy 6% each; Bird, Jovanovic 12% each) and a PhD studentship. The application is also supported by Eat London NHS Foundation Trust (in 2016 rated ‘outstanding’ by CQC and winner of HSJ award ‘Provider Organisation of the Year’). ELFT will fund the work of two employees (Giacco 12%, Baillie 3%). PARTNERSHIPS ESTABLISHED We have established strong links to centres in Bosnia-Herzegovina, Colombia and Uganda. In Bosnia-Herzegovina we are working with The Clinical Centre at The University of Sarajevo. In Colombia, we are partnered with The University of Javeriana and are working in several clinical sites in Bogotá and Cali. In Uganda, our main partner is Makerere University College of Health Sciences and we are working in Kampala at the Butabika Hospital and three other clinical sites based in Jinja, Masaka and Mitiyana. ACTIVITIES Work has begun with our partners at all sites in Bosnia-Herzegovina, Colombia, Uganda. At each centre a research group including senior academics has been trained, and continuous supervision and support is provided by the local Principal Investigators along with the UK team. The partners have completed situation analyses on mental health funding, provision and policies, within their contexts. All partners have identified and set up links with collaborating clinical centres and organizations to deliver a range of psychosocial interventions. All partners actively engaged with local stakeholders to involve supportive organisations and people who were then trained in delivering psychosocial interventions. This included different professional groups, e.g. nurses, social workers and pharmacists, and non-professionals, i.e. volunteers, peers, and family members. Each partner has adapted, designed and will be testing a range of evidence-based and resource-oriented interventions for people with severe mental illnesses in the community: 1) The DIALOG+ intervention, which is an easy to train IT supported method – developed by the research group - to guide the routine communication between a patient and a clinician or a trained layperson. DIALOG+ delivers assessment, planning, therapeutic intervention and evaluation in one procedure. 2) Befriending of non-professionals with single or groups of patients, utilising social networks and community support. 3) Family support through professional or non-professional staff. The interventions have been adapted to the local context but are in line with the MRC framework for developing and evaluating complex interventions and adhere to high methodological standards. The interventions are being tested in a range of Randomised Controlled Trials (RCTs) and non-controlled trials. Working on 3 studies will widen the methodological expertise, provide a range of practical experiences and explore specific local benefits. T
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