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Improving outcomes for people with psychosis in Pakistan and India – enhancing the Effectiveness of Community-based care (PIECEs)


Psychosis is a serious mental illness and can be very distressing for individuals and their families. Chronic psychosis affects >2% of the world’s population causing significant distress to individuals, families and wider communities, and leads to high societal costs. 

People with psychosis often suffer from poor quality of life, with many patients being unable to receive the treatment they need. 

Suffering from this ‘treatment gap,’ three out of four people with psychosis in low and middle-income countries – like Pakistan –  cannot access appropriate care. 

When individuals are able to access treatment, it is often in hospitals, away from their family and community. Additionally, with limited financial resources or trained staff, it is difficult to provide specialized care. Low-cost, effective interventions are an urgent priority.


PIECEs is a cross-country program, which aims to improve treatment, mental health and quality of life outcomes for people with psychosis by using an app, DIALOG+. 

The app enhances the therapeutic alliance between mental health providers and people with psychosis, aiming to improve the quality of community-based care for people with psychosis in Pakistan and India. 

By adapting and testing DIALOG+, people with psychosis can have a better quality of life and a chance to reduce their symptoms. IRD will be testing this approach in Pakistan for the first time through 2021 to 2024.

PIECEs will undertake five interlinked work packages (WPs) as part of the research study to:  

WP1 – ensure the contextualization of DIALOG+

WP2 – Randomized Control Trial (RCT) – test the efficacy and cost-effectiveness of the adapted DIALOG+ through a randomised controlled trial

WP3 – conduct a qualitative evaluation to identify and address barriers to delivery  

WP4 – enhance service and research capacity through mass skill-building program

WP5 – engage with local communities through arts-based methods including ‘Theatre of the Oppressed’, giving voice to people with psychosis and promoting new understandings for research

IRD is leading the cross-country PIECEs project in Pakistan. Other collaborating partners include Queen Mary University in London, Interactive Research and Development, Schizophrenia Research Foundation and People’s Palace Projects.


The PIECEs team established partnerships in Karachi for the delivery of DIALOG+ pilot and RCT (Karwan-e-Hayat and the Department of Psychiatry and Behavioural Sciences at Jinnah Postgraduate Medical Centre).

Establishing a Lived Experience Advisory Panel consisting of people with psychosis and caregivers, the project will embed the needs of people with lived experience of SMIs in intervention adaptation, research delivery and analysis.

The project has thus far conducted a situation analysis and explored care pathways for 2 clinical sites delivering mental health treatment and support for people with psychosis to inform intervention delivery.

In the PIECEs pipeline is an RCT to test the effectiveness and cost-effectiveness of DIALOG+ in Pakistan due to begin in January 2022.

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