The Impact of the COVID-19 Pandemic on People with Severe Mental Illness and on Mental Health Service Provision in South Asia (IMPASS)

Lead Research Organisation: University of York
Department Name: Health Science

Abstract

The COVID-19 pandemic has greatly affected lives and challenged access to healthcare in many low and middle income countries, including Pakistan and Bangladesh. People with severe mental illness (SMI) are at particularly high risk of being affected, as are mental health services. SMI refers to illnesses such as schizophrenia and bipolar disorder that affect people's thinking (often experiencing delusions and hallucinations) and severely reduce their life chances. This study builds on our existing collaborations and research set-up in South Asia, to deliver:
1. A survey in people with SMI, and interviews with them and their families to explore understanding and response to public health advice, and the pandemic's impact on health, behaviours e.g. smoking, access to healthcare, security, income and quality of life.
2. Surveys at mental health hospitals and staff interviews to explore impacts on mental health services.
3. Workshops with key stakeholders to jointly produce research questions that are important to them, and interpret findings.
We have already established 'Community Panels' comprising people with SMI and advocacy organisations, who will advise on the research. We will also strengthen expertise in the research team and policy makers to make use of research findings in practice.
Findings will inform approaches to reduce the impact of the current and future pandemics, and be of value to people with SMI, health providers and policy makers in South Asia and other LMIC. They will be publicised using print and social media, reports, TV & radio and academic journals.

Technical Summary

The COVID-19 pandemic has adversely affected lives and challenged healthcare provision. Those with severe mental illness (SMI; e.g. schizophrenia, bipolar disorder) are likely to be disproportionately affected.
Aims & objectives: Investigate impact of the pandemic and its response on people with SMI and on mental health care in Bangladesh and Pakistan. Specifically, for people with SMI, to:
a.Explore receipt and response to advice about preventing spread of Covid-19 b.Understand impact on well-being, health, health risk behaviours, quality of life; access to/receipt of mental & physical healthcare; housing and food security, domestic violence, employment, income
c.Explore impacts on mental health care
d.Inform strategies to mitigate the impact of the pandemic on people with SMI and healthcare services.
Methods: Using our existing research collaborations and infrastructure, including a current SMI cohort, we will conduct:1.Quarterly surveys of people with SMI (N=>2K). 2.Semi- structured telephone interviews with patients (N=15-20), families (N=5-10) and mental healthcare workers (N=15-20) in each country. 3.Mental health facility surveys repeated 6- monthly. 4.Joint stakeholder workshops, to present emerging findings, receive feedback and iteratively co-design survey/interview questions, ensuring they are responsive to the evolving pandemic and policy context. Outputs will inform planning to mitigate impact for current and future waves of Covid-19 and other similar epidemics.
People with SMI, their families and advocacy organisations will be involved at all stages. We will build capacity in applied research and leadership through experiential learning and training.
Impact & dissemination: A Working Group (with patients, families, practitioners and policy makers), and stakeholder workshops will co-produce a targeted, rapid dissemination strategy, including e.g. policy briefs, print/social media, radio/TV and journal articles, using Theory of Change principles.
 
Title Access to care and breakdown the stigma associated with Mental Health 
Description Mental health awareness digital campaign showcasing IMPASS project outcomes. 
Type Of Art Artefact (including digital) 
Year Produced 2023 
Impact Highlighting the mental health importance in the general public and disseminating the IMPASS project outcomes. 
URL https://www.facebook.com/theimpassproject/posts/pfbid0y4J5395vhhVdQQJ5Mo7DYR9j6BNSh61N8Ci4Uzt6tCNZCB...
 
Title Approaches to minimise pandemic impact and benefit SMI people 
Description Mental health awareness digital campaign showcasing IMPASS project outcomes. 
Type Of Art Artefact (including digital) 
Year Produced 2023 
Impact Highlighting the mental health importance in the general public and disseminating the IMPASS project outcomes. 
URL https://www.facebook.com/theimpassproject/posts/
 
Title Cloud Of Depression 
Description In this powerful video animation, titled "The Cloud of Depression," we dive deep into the emotional journey of a woman as she grapples with the overwhelming weight of depression. Witness her raw and honest portrayal as she confronts the challenges, frustrations, and isolation that this mental health condition can bring. Through evocative visuals and heartfelt storytelling, we shed light on the devastating impact depression can have on one's life. As the dark cloud of depression engulfs her, we observe the toll it takes on her relationships, aspirations, and overall well-being. However, this video is not merely a tale of despair; it is a story of resilience and hope. As our protagonist finds the strength to seek help and adopt coping mechanisms, a glimmer of light emerges. Step by step, she embarks on a journey towards healing and self-discovery. Witness the transformative power of self-care, therapy, and support systems as our protagonist begins to reclaim her life. Through this video, we aim to inspire and provide solace to those who may be struggling with their own battles against depression. "The Cloud of Depression" is a poignant reminder that no one is alone in their mental health journey. Join us as we raise awareness, foster empathy, and encourage open conversations about depression, ultimately fostering a more compassionate and understanding society. 
Type Of Art Film/Video/Animation 
Year Produced 2023 
Impact The animated video, cloud of depression has been distributed to both public and private healthcare providers, available for free use in five regional languages as well as English. Government agencies, healthcare institutions, and research projects can utilize this video to raise awareness among the general public. Its reach extends nationally and internationally through a shared YouTube link, ensuring widespread accessibility and impact 
URL https://youtu.be/5QF2dMv7sFM?si=hZsQLKipSWX4Ue3Y
 
Title Highligting the importance of mental health awareness 
Description Mental health awareness digital campaign showcasing IMPASS project outcomes. 
Type Of Art Artefact (including digital) 
Year Produced 2023 
Impact Highlighting the mental health importance in the general public and disseminating the IMPASS project outcomes. 
URL https://twitter.com/impassproject/status/1632652234650705925/photo/1
 
Title Integrating mental and physical health in Pakistan 
Description Mental health awareness digital campaign showcasing IMPASS project outcomes. 
Type Of Art Artefact (including digital) 
Year Produced 2023 
Impact Highlighting the mental health importance in the general public and disseminating the IMPASS project outcomes. 
URL https://twitter.com/impassproject/status/1632818327855968256/photo/1
 
Title Integrating smoking cessation services as a routine care for SMI people 
Description Mental health awareness digital campaign showcasing IMPASS project outcomes. 
Type Of Art Artefact (including digital) 
Year Produced 2023 
Impact Highlighting the mental health importance in the general public and disseminating the IMPASS project outcomes. 
URL https://twitter.com/impassproject/status/1633407212537143297/photo/1
 
Title Mental health a critical issue affecting communities globally 
Description Mental health awareness digital campaign showcasing IMPASS project outcomes. 
Type Of Art Artefact (including digital) 
Year Produced 2023 
Impact Highlighting the mental health importance in the general public and disseminating the IMPASS project outcomes. 
URL https://www.facebook.com/theimpassproject/posts/pfbid0ogsACfXP8rDPizxknWVSRR2xdLmH7QJEPtYWv7aaYCoSYd...
 
Title Mental health impacts daily functioning and requires ongoing support for SMI people. 
Description Mental health awareness digital campaign showcasing IMPASS project outcomes. 
Type Of Art Artefact (including digital) 
Year Produced 2023 
Impact Highlighting the mental health importance in the general public and disseminating the IMPASS project outcomes. 
URL https://www.facebook.com/theimpassproject/posts/pfbid0tzqZiBsq8ppQv2tCTAHrTiGhS5FZ8ExGTiRn2QiHisMKYb...
 
Title Mitigate the impact of Pandemic and its response on mental health 
Description Mental health awareness digital campaign showcasing IMPASS project outcomes. 
Type Of Art Artefact (including digital) 
Year Produced 2023 
Impact Highlighting the mental health importance in the general public and disseminating the IMPASS project outcomes. 
URL https://www.facebook.com/theimpassproject/posts/
 
Title Physical health of mentally ill 
Description Neglected people and an ignored subject. An Op-ed in Dawn newspaper on the physical health of mentally ill by Dr Zafar Mirza who is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC 
Type Of Art Creative Writing 
Year Produced 2023 
Impact Increased awareness: The op-ed helped in raising awareness about the physical health needs of individuals living with mental illness. Many people may not be aware of the higher risk of physical health problems that people with mental illness face, so the op-ed brought attention to this issue. Policy changes: This op-ed was written by a prominent stakeholder-, it could potentially lead to policy changes that address the physical health needs of mentally ill individuals. Improved health outcomes: By highlighting the physical health risks associated with mental illness, the op-ed may have encouraged more people with mental illness to seek out physical health care. This, in turn, could lead to improved health outcomes for these individuals, as their physical health needs are identified and addressed. Reduction of stigma: The op-ed could also help reduce the stigma that is often associated with mental illness. By emphasizing that mental illness is a health condition like any other, and by highlighting the physical health risks associated with it, the op-ed can help challenge negative attitudes and beliefs about mental illness. Increased awareness: The op-ed can help raise awareness about the physical health needs of individuals living with mental illness. Many people may not be aware of the higher risk of physical health problems that people with mental illness face, so the op-ed can help bring attention to this issue. Policy changes: If the op-ed is well-written and persuasive, it could potentially lead to policy changes that address the physical health needs of mentally ill individuals. For example, it could prompt lawmakers to allocate more funding to programs that provide physical health care to people with mental illness. Improved health outcomes: By highlighting the physical health risks associated with mental illness, the op-ed may encourage more people with mental illness to seek out physical health care. This, in turn, could lead to improved health outcomes for these individuals, as their physical health needs are identified and addressed. Reduction of stigma: The op-ed could also help reduce the stigma that is often associated with mental illness. By emphasizing that mental illness is a health condition like any other, and by highlighting the physical health risks associated with it, the op-ed can help challenge negative attitudes and beliefs about mental illness. 
URL https://www.dawn.com/news/1743935/physical-health-of-mentally-ill
 
Title Prevalance of Depression and anxiety and other mental health conditions 
Description Mental health awareness digital campaign showcasing IMPASS project outcomes. 
Type Of Art Artefact (including digital) 
Year Produced 2023 
Impact Highlighting the mental health importance in the general public and disseminating the IMPASS project outcomes. 
URL https://www.facebook.com/theimpassproject/posts/pfbid0q6t8gsL8LhC3GT6pVune7cwZp9RtJ4estG9NtTrz59JbLR...
 
Title Promoting COVID 19 vaccine for people with SMI 
Description Mental health awareness digital campaign showcasing IMPASS project outcomes. 
Type Of Art Artefact (including digital) 
Year Produced 2023 
Impact Highlighting the mental health importance in the general public and disseminating the IMPASS project outcomes. 
URL https://twitter.com/impassproject/status/1632259648358342656/photo/1
 
Title Stigma associaated to mental health and inequality to provide mental health services 
Description Mental health awareness digital campaign showcasing IMPASS project outcomes. 
Type Of Art Artefact (including digital) 
Year Produced 2023 
Impact Highlighting the mental health importance in the general public and disseminating the IMPASS project outcomes. 
URL https://www.facebook.com/theimpassproject/posts/pfbid02EpGrHhxvBk13USnwF9f8eo2fbmiyhJQ1nyMbgXVbf9AdB...
 
Description Key findings of telephone surveys of people with SMI (existing cohorts; 6 rounds):
COVID knowledge and practice
Mass media was the major source of information about COVID-19. Overall, participants reported good knowledge and following of advice. In Bangladesh, being female and higher levels of health-related quality of life (HRQoL) predicted poorer and better knowledge, respectively. In Pakistan being female predicted better knowledge. Receiving information from television predicted better knowledge in both countries. In Bangladesh, being female, accessing information from multiple media sources, and better HRQoL predicted better practice. In Pakistan, poorer knowledge of COVID-19 prevention measures predicted poorer practice.

Economic challenges
Food insecurity was higher when the COVID-19 pandemic was at its peak (around 40% Bangladesh; 25% Pakistan). Level of education and financial management were found to be significantly associated with food insecurity
Finance - People with SMI reported to have at least mild financial challenges which eased over time.

COVID-19 vaccine uptake - Among unvaccinated people at wave 5, 37% were vaccine hesitant in Bangladesh compared to 63% in Pakistan. •17% of vaccine hesitant participants in Bangladesh were concerned about vaccine side effects, compared to 45% in Pakistan. •Place of living (urban), good financial management, mental wellbeing, higher HRQoL, relapse of mental illness, being tested for coronavirus and favorable attitude towards COVID-19 vaccine were positively associated with vaccine hesitancy.

Mental health - Depression and anxiety: The severity of depression decreased throughout the pandemic in both countries. In Bangladesh, the adjusted mean difference (AMD) of the PHQ-9 score at the first follow-up survey compared to baseline was -3.66 (95% CI: -4.10 to -3.21; p<0.001), This difference decreased during the study and at the final survey was -2.28 (95% CI: -2.79 to -1.77); p<0.001). In Pakistan, the AMD at the first follow-up survey was -6.02 (95% CI: -6.73 to -5.32); p<0.001) and -8.36 (95% CI: -8.94 to -7.78; p<0.001) at the final survey. A similar pattern was observed when assessing the change in the severity of anxiety. In Bangladesh, the AMD at the first follow-up survey compared to baseline was -3.51 (95% CI: -3.88 to -3.14; p<0.001) and decreased during the study to -2.20 (95% CI: -2.65 to -1.75; p<0.001). In Pakistan the AMD at the first follow-up survey was -4.90 (95% CI: -5.49 to -4.32; p<0.001) and at the final follow-up survey was -6.83 (95% CI: -7.30 to -6.37; p<0.001).

Wellbeing - Mental wellbeing was not measured at the baseline survey, but was collected at each of the six waves. In Bangladesh, the average sWEMWBS score remained around 20 points during waves 1-5, rising to 22 points at wave 6. In Pakistan, the average sWEMWBS score was 17.5 points at wave 1, rising to 22.5 points by wave 6. In Bangladesh, participants with no formal education had worse well-being during the course of the pandemic, with a similar but weaker effect being observed in Pakistan. In Bangladesh, unemployed participants had worse wellbeing during the course of the pandemic. In both countries, a longer duration of having SMI was associated with worse wellbeing.

B-Interviews with people with SMI, carers & healthcare staff - Objective 1: Understanding of Covid-19
There was a basic understanding of COVID-19 and how to prevent its spread, as time passed fear of COVID-19 reduced and behaviour changed over the course of the pandemic - Understanding Covid-19 as viral disease, passed from person to person and ways of prevention include social distancing and mask wearing. - Sources of knowledge included: social media, the internet, friends, family, health professionals. - Initially many people were very afraid of Covid-19. - Behaviour also depended on personal experience. -Fear subsided over the course of the pandemic and many found it not practical to continue with precautions such as social distancing
"You wear a mask, sanitise your hands, keep away from people, don't shake hands" Person with SMI in Pakistan. "Back in 2020, we all were in extreme fear of getting this disease. But that feeling has gone now. Although more people are dying from coronavirus, it has become a part of our life" Carer in Bangladesh.

Objective 2: Impact of the pandemic on health, access to healthcare, and social and economic factors
The economic and social impact of COVID-19 are viewed as worse than COVID-19; there was a reduced access to health care. - Carers described changes in their relatives' physical health. - Anxiety, fear and stress increased among people with SMI. - Reduced access to healthcare: services for mental health were restricted in 2020, and people were afraid to seek care. - Costs of medicines increased and access to medicines were restricted. -Transportation was limited and the cost to get to services increased. - Huge economic strains - people/family members lost jobs, costs of food increased. -Economic strain caused tensions within households. - Social isolation and loneliness was a big problem. "my younger son has lost his job and now he is struggling to get another job, lockdown is very hard on us.we have to borrow lots of money and still we are unable to return the loan" Person with SMI in Pakistan. "During Covid, patients suffered as services closed" Health Professional in Bangladesh.

Objective 3: Impact of the pandemic on health professionals
Changes and strains on the mental health system were very stressful for healthcare staff and they lacked support. - Mental health services were neglected and reduced at the beginning of the pandemic. - Many mental health staff were re-deployed and asked to take on additional work; as well as follow new protocols and learn new systems (i.e. for recording cases and remote care). - Lack of preparation and PPE. - Very stressful. - Lack of emotional support for staff. "I was very anxious, because no specific training was given, I was in the mental health ward and they told me to go to COVID ward, suddenly patients started coming, there was a lot of anxiety.. I wanted to resign from the job" Health worker in Pakistan. "We did not increase our manpower. Rather, we had to increase the workload" Health worker in Bangladesh

Objective 4: Barriers and facilitators to Covid-19 vaccine uptake
Uptake of Covid-19 vaccines were context specific, with support being an important enabler. - Bangladesh: most people with SMI planned to have their vaccines, but were unable to because of problems with registration and supply of the vaccine. - Bangladesh: main enabler - friends and families having their vaccines, support from relatives with registering for the vaccine. - Pakistan: barriers: fear of the side effects of the vaccine, suspicions and rumors about the vaccines/safety/motivations; however the vase majority of participants had had their vaccine. - Pakistan: main reason given for uptake of the vaccine was the restrictions to services and/or working if one is not vaccinated. "My sister and her husband helped me to complete my registration to get vaccinated. I will recommend that my neighbours and relatives to get vaccinated" Person with SMI in Bangladesh. "I don't know why China is giving us the vaccine free of cost, we have to wonder what their purpose is. People are saying after two years you will die [from the vaccine]. I don't trust anyone." Person with SMI in Pakistan.

C-Survey of mental health facilities
PAKISTAN - A total of 55 facilities were mapped in Pakistan, of which 40 agreed to take part in the survey and 31 complete responses were obtained. 51.6% facilities were tertiary care without university hospitals, 41.9% were tertiary care with university hospitals and 6.5% were secondary care.
Survey Results - 16/31 Outpatient services were functional. 16/31 Outpatient services were functional. 13/25 Inpatient services were functional. 21/31 emergency services were functional

Mental Health Services during COVID-19
During the Coronavirus pandemic, the number of people using mental health services dropped to approximately 50%. Main causes of service disruption (principal reported causes):
Decrease in outpatient volume due to patients not presenting = 80.6%. Insufficient staff to provide services = 38.7%. Decrease in in-patient volume due to cancellation of elective care = 45.2%. Clinical staff related to mental disorders deployed to provide COVID-19 clinical management or emergency support = 48.4%.

Approaches to service delivery (principal reported approaches): Telemedicine/teletherapy deployment to replace in person consultations = 51.6%. Helplines established for mental health and psychosocial support = 45.2%. Healthcare providers working in COVID-19 treatment centers trained in basic psychosocial skills = 32.3%. Triaging to identify priorities = 42%. Implementation of specific measures for infection prevention and control in mental health services = 25.8%.
Covid screening and Tele-medicine services which were fully functional - Screening services for COVID-19 available on arrival in out-patient department = 67.7%. Hand hygiene products (soap or alcohol-based hand rub) provided for patients = 97.7%. Facility been using telemedicine/tele-psychiatry platforms / mHealth/ mobile phone-based psychotherapy during COVID-19 = 61.2%. Facilities offer vaccination for SMI patients = 78%

BANGLADESH - Health Facility Mapping. A total of 41 health facilities were mapped of which 24 had a mental health department. Complete responses were obtained from 19 mental health facilities. These were all tertiary level mental healthcare facilities. Main causes of service disruption (principal reported causes): Decrease in outpatient volume due to patients not presenting = 68%. Insufficient staff to provide services = 53%. Decrease in in-patient volume due to cancellation of elective care = 53%. Clinical staff related to mental disorders deployed to provide COVID-19 clinical management or emergency support = 48%

Approaches to service delivery (principal reported approaches): Telemedicine/teletherapy deployment to replace in person consultations =- 78%. Helplines established for mental health and psychosocial support = 68%. Healthcare providers working in COVID-19 treatment centers trained in basic psychosocial skills = 47%. Triaging to identify priorities = 42%. Implementation of specific measures for infection prevention and control in mental health services = 42%.

COVID screening and tele-medicine services which were fully functional - Screening services for COVID-19 available on arrival in out-patient department = 36.8%. Hand hygiene products (soap or alcohol-based hand rub) provided for patients = 42.1%. Facility already using telemedicine/tele-psychiatry platforms / mHealth/ mobile phone-based psychotherapy during COVID-19 = 21.1%. Facilities offering vaccination for SMI patients = 36.8%

Overall Insights - Both countries experienced major disruptions in mental healthcare provision. Infection control measures were used but the implementation was not uniform. Mitigation strategies like telepsychiatry, helplines and triage were mainly used.

D-Literature reviews - Summary results: 21 studies reported rates of vaccination uptake in people with SMI compared to the general population / people with other health conditions. All studies in high income countries; vaccines were mainly free. Most focused on COVID-19; some studies on influenza uptake. Some qualitative studies focused on barriers to uptake in low and middle income countries. For COVID-19 studies in random effect meta-analysis, while rates of vaccination uptake were lower (OR 0.87) in people with SMI compared to the non-SMI population this difference was not significant (0.60 - 1.26).
COVID vaccine rollout - prioritized mainly by age in studies rather than disease group. In intervention review only 3 studies looked at evidence on interventions intended to increase uptake of vaccination in people with SMI; none of these were in low or middle income countries. This remains a gap in knowledge.

Conclusions: Relatively limited evidence base. Most (but not all) studies point to lower uptake of vaccination in SMI groups, but no evidence from low and middle-income countries in review. Range of qualitative insights on barriers to access including: cost, misconceptions on vaccination; perception of low risk of illness; being young, religious status, being childless, as well as limited infrastructure/ transport. Very limited evidence on interventions to promote uptake of vaccination - all quasi-experimental with limited (if any) impact.
Exploitation Route Implications for policy and practice:
There need to be alternative mechanisms for care seeking for SMI patients in emergency situations. The socioeconomic impact of lockdowns are huge - these need to be considered by policy makers and health care staff. There needs to be better preparedness for staff - thinking of their mental health as well as the mental health of patients. Need to have support systems for healthcare staff. Potential for remote services outside of emergency services. Importance of policy and structures as well as community engagement in vaccination campaigns

Conclusion and way forward
The data collected by the IMPASS study is a great source to understand and address the unmet needs of the stigmatized and marginalized SMI populations in Bangladesh and Pakistan. The findings highlight the gaps in the current health system of Pakistan, where mental health is often neglected and can feed into the formulation of the national Mental Health Action Framework, providing valuable insights for policymakers and stakeholders. Our analysis indicates that in both Bangladesh and Pakistan, the mental health of the general population can also be at high risk during pandemics like Covid-19. However, the IMPASS study has provided timely information regarding the mental and physical health of the SMI population. This population in both countries has had to contend with additional challenges during the pandemic, including some difficulties in accessing health services which were compounded by the economic / food security challenges faced during the pandemic. The findings of different, but linked components of IMPASS, including input from people living with SMI, as well as local policy makers, surveys, and literature review does however provide valuable insights on steps that could be taken in future to mitigate the impacts of a pandemic or similar public health emergency. This could include providing additional targeted support to high risk population groups including people with SMI and as well as their family members.
Sectors Communities and Social Services/Policy

Healthcare
URL https://www.impactsouthasia.com/impass/
 
Description Impact of the IMPASS Project on Policy and Practice To maximize opportunities to influence policy and practice - strong relationships were established with the key stakeholders from the start of the program. Apart from informal meetings, a series of stakeholder meetings were organized (2 in Bangladesh & 2 in Pakistan).This facilitated in jointly identifying research questions & their outcomes to be translated to policy and practice and to codesign strategies to mitigate impact of COVID on Severe Mental Illnesses. In Bangladesh, the key policymakers who participated were officials from the WHO Country Office, National Institute of Mental Health (NIMH), Bangladesh Association of Psychiatry, Directorate of Health of Dhaka, North City Corporation, donor partners and civil society. In Pakistan, the key policymakers who participated were officials from the WHO Country Office, Former Advisor on Health to the Prime Minister, Ministry of National Health Services, Regulation & Coordination, National Institute of Health, President & Executive Members of Pakistan Psychiatric Society and Non Government Organizations working for mental health. Research Policy Forum - Bangladesh Prioritize preventive measures by addressing the interrelation between mental and physical health. Strengthen mental health service in Primary Health Care using the mh GAP (mental health Gap Action Programme) tool in NCDs. Health Insurance for mental health via South City Corporation Government health insurance scheme (SSK). Advocacy for ensuring availability of 6 essential medication for mental illnesses at primary health care in Upazila Health Complex. Addressing mental health issues in Medical Education curriculum through meeting with Bangladesh Medical and Dental Council (BMDC) Research Policy Forum - Pakistan Implementation of Universal Health Coverage (UHC) and Essential Package of Health Services (EPHS) by the Government of Pakistan. Screening and referrals for people with mental health issues to be included in the primary health care level of UHC. Implementation of Telehealth and Telemedicine in accessing healthcare, with potential expansion to include telepsychiatry at Tertiary Care Facilities. Feedback mechanisms from family and service users to influence the development of mental health services. Importance of documenting successful strategies and lessons learned for future disaster management Implementation of the National Action Framework (NAF) for NCDs and Mental Health (2021-2030) Develop a comprehensive plan for decentralization of services and improved mental health facilities. Awareness about mental health amongst the general public and stakeholders, making mental health a top priority for the Government in the event of future public health emergencies. Develop a National Mental Health Helpline for routine and public health emergencies for accessible mental health support. Develop the National Mental Health Policy by the Pakistan Psychiatric Society & Government of Pakistan. Policy statement for Policy & Practice Policy makers emphasized the importance of providing mental health support at the primary care level, integrating mental health into medical training, and improving accessibility to services during crises. All stakeholders in Bangladesh and Pakistan endorsed a statement acknowledging the heightened vulnerability of individuals with severe mental illness to both physical and mental health challenges, particularly during pandemics like COVID-19 and related measures such as lockdowns and social distancing and to device strategies learning from the IMPASS Project. Capacity building Surveys, interviews, qualitative analysis, evidence synthesis Community engagement & stakeholder involvement events Writing briefs for lay audiences & policy makers Getting research into policy- workshop Good Clinical Research Practice 47 participants from Pakistan face to face; 7 from Bangladesh attended via zoom NIHR Global Health Research Group, IMPACT in S Asia & DiaDeM RIGHT programme capacity building activities Conclusion and way forward The data collected by the IMPASS study is a great source to understand and address the unmet needs of the stigmatized and marginalized SMI populations in Bangladesh and Pakistan. The findings highlight the gaps in the current health system of Pakistan, where mental health is often neglected and can feed into the formulation of the national Mental Health Action Framework, providing valuable insights for policymakers and stakeholders. Our analysis indicates that in both Bangladesh and Pakistan, the mental health of the general population can also be at high risk during pandemics like Covid-19. However, the IMPASS study has provided timely information regarding the mental and physical health of the SMI population. This population in both countries has had to contend with additional challenges during the pandemic, including some difficulties in accessing health services which were compounded by the economic / food security challenges faced during the pandemic. The findings of different, but linked components of IMPASS, including input from people living with SMI, as well as local policy makers, surveys, and literature review does however provide valuable insights on steps that could be taken in future to mitigate the impacts of a pandemic or similar public health emergency. This could include providing additional targeted support to high risk population groups including people with SMI and as well as their family members.
First Year Of Impact 2021
Impact Types Policy & public services
 
Description 1st Stakeholder workshop-Bangladesh-IMPASS
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
Impact the network is hoped to be successful in bringing together academics and experts from across Bangladesh to build health economics research capacity in the country, and facilitate related research in the future.
 
Description 1st Stakeholder workshop-IMPASS
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
Impact The stakeholder's workshop resulted in creating awareness for the policymakers and building a consensus on being more prepared and designing more inclusive and suitable policies for any such pandemics in future.
URL https://drive.google.com/file/d/1g2z-CzY2BeFZeToFMrx5xgb5fA-V2SFa/view?usp=sharing
 
Description 2nd Community Advisory panel workshop-Bangladesh
Geographic Reach National 
Policy Influence Type Participation in a guidance/advisory committee
Impact Feedback on the project was received which will in turn feed into the stakeholder workshop of policymakers.
 
Description 2nd Community Advisory panel workshop-Pakistan
Geographic Reach National 
Policy Influence Type Participation in a guidance/advisory committee
Impact The CAP workshop aimed at informing the patients, treatment supporters, healthcare providers, and Social officers regarding the project results/outcomes as well as discussed how can mental health be improved in case of any pandemic like this occurs in future.
 
Description 2nd Stakeholder workshop-Bangladesh-IMPASS
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
Impact Sharing research findings, geeting feedbck and how to translate research into policy and practice, and agreeing statement
 
Description 2nd Stakeholder workshop-Bangladesh-IMPASS
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
Impact Sharing research findings, geeting feedbck and how to translate research into policy and practice, and agreeing statement
 
Description 2nd Stakeholder workshop-IMPASS
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
Impact Two of the Objectives of this workshop were: 1. Discussion on how the IMPASS Findings can inform and help in the formulation of National Mental Health Policy. 2. Discussion on how to help people with mental health problems in case of any future pandemics (or similar public health emergencies).
 
Description Community Advisory panel workshop
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Participation in a guidance/advisory committee
Impact CAP workshop led to suggestions made by patients and their caregivers for the Stakeholder workshop to which policymakers were invited. CAP workshop brief summary was provided to Policy makers.
 
Description Formulation of National Mental Health Policy draft
Geographic Reach National 
Policy Influence Type Contribution to a national consultation/review
Impact The National mental health policy once finalized will be for the benefit of the vulnerable population namely SMI in all aspects regarding health care services..
 
Description Getting Research into Policy & Practice
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact The workshop will equip the researchers enrolled in various research projects to understand ways of transforming research into policymaking and utilizing it to design more inclusive, sustainable and implementable policies.
URL https://drive.google.com/file/d/1AaPcnjC4mlnaLwb74rAbskoni9znWoXK/view?usp=sharing
 
Description IMPASS 
Organisation ARK Foundation Bangladesh
Country Bangladesh 
Sector Charity/Non Profit 
PI Contribution Led the collaboration
Collaborator Contribution The following external collaborators contribute to the IMPASS project, Prof. Kamran Siddiqi , Dr. Helen Elsey, Dr. Hannah Jennings University of York,Prof. Saeed Farooq Keele University & Midlands Partnership NHS Foundation Trust, Prof. David McDaid London School of Economics & Political Science, Dr. Jan Boehnke University of Dundee,Prof. Pratima Murthy, National Institute of Mental Health & Neuro Sciences India,Dr. Rumana Haque ARK Foundation, Bangladesh,Dr. Helal Uddin Ahmed National Institute of Mental Health, Dhaka, Bangladesh University of York, UK
Impact The collaboration is multi-disciplinary and includes expertise from psychiatry, public health, epidemiology, physical and mental health comorbidity experts and health economists.
Start Year 2021
 
Description IMPASS 
Organisation Keele University
Country United Kingdom 
Sector Academic/University 
PI Contribution Led the collaboration
Collaborator Contribution The following external collaborators contribute to the IMPASS project, Prof. Kamran Siddiqi , Dr. Helen Elsey, Dr. Hannah Jennings University of York,Prof. Saeed Farooq Keele University & Midlands Partnership NHS Foundation Trust, Prof. David McDaid London School of Economics & Political Science, Dr. Jan Boehnke University of Dundee,Prof. Pratima Murthy, National Institute of Mental Health & Neuro Sciences India,Dr. Rumana Haque ARK Foundation, Bangladesh,Dr. Helal Uddin Ahmed National Institute of Mental Health, Dhaka, Bangladesh University of York, UK
Impact The collaboration is multi-disciplinary and includes expertise from psychiatry, public health, epidemiology, physical and mental health comorbidity experts and health economists.
Start Year 2021
 
Description IMPASS 
Organisation London School of Economics and Political Science (University of London)
Department LSE Health and Social Care
Country United Kingdom 
Sector Academic/University 
PI Contribution Led the collaboration
Collaborator Contribution The following external collaborators contribute to the IMPASS project, Prof. Kamran Siddiqi , Dr. Helen Elsey, Dr. Hannah Jennings University of York,Prof. Saeed Farooq Keele University & Midlands Partnership NHS Foundation Trust, Prof. David McDaid London School of Economics & Political Science, Dr. Jan Boehnke University of Dundee,Prof. Pratima Murthy, National Institute of Mental Health & Neuro Sciences India,Dr. Rumana Haque ARK Foundation, Bangladesh,Dr. Helal Uddin Ahmed National Institute of Mental Health, Dhaka, Bangladesh University of York, UK
Impact The collaboration is multi-disciplinary and includes expertise from psychiatry, public health, epidemiology, physical and mental health comorbidity experts and health economists.
Start Year 2021
 
Description IMPASS 
Organisation National Institute of Mental Health and Hospital, Bangladesh
Country Bangladesh 
Sector Public 
PI Contribution Led the collaboration
Collaborator Contribution The following external collaborators contribute to the IMPASS project, Prof. Kamran Siddiqi , Dr. Helen Elsey, Dr. Hannah Jennings University of York,Prof. Saeed Farooq Keele University & Midlands Partnership NHS Foundation Trust, Prof. David McDaid London School of Economics & Political Science, Dr. Jan Boehnke University of Dundee,Prof. Pratima Murthy, National Institute of Mental Health & Neuro Sciences India,Dr. Rumana Haque ARK Foundation, Bangladesh,Dr. Helal Uddin Ahmed National Institute of Mental Health, Dhaka, Bangladesh University of York, UK
Impact The collaboration is multi-disciplinary and includes expertise from psychiatry, public health, epidemiology, physical and mental health comorbidity experts and health economists.
Start Year 2021
 
Description IMPASS 
Organisation National Institute of Mental Health and Neurosciences
Country India 
Sector Hospitals 
PI Contribution Led the collaboration
Collaborator Contribution The following external collaborators contribute to the IMPASS project, Prof. Kamran Siddiqi , Dr. Helen Elsey, Dr. Hannah Jennings University of York,Prof. Saeed Farooq Keele University & Midlands Partnership NHS Foundation Trust, Prof. David McDaid London School of Economics & Political Science, Dr. Jan Boehnke University of Dundee,Prof. Pratima Murthy, National Institute of Mental Health & Neuro Sciences India,Dr. Rumana Haque ARK Foundation, Bangladesh,Dr. Helal Uddin Ahmed National Institute of Mental Health, Dhaka, Bangladesh University of York, UK
Impact The collaboration is multi-disciplinary and includes expertise from psychiatry, public health, epidemiology, physical and mental health comorbidity experts and health economists.
Start Year 2021
 
Description IMPASS 
Organisation University of Dundee
Department Community Health Sciences Division
Country United Kingdom 
Sector Academic/University 
PI Contribution Led the collaboration
Collaborator Contribution The following external collaborators contribute to the IMPASS project, Prof. Kamran Siddiqi , Dr. Helen Elsey, Dr. Hannah Jennings University of York,Prof. Saeed Farooq Keele University & Midlands Partnership NHS Foundation Trust, Prof. David McDaid London School of Economics & Political Science, Dr. Jan Boehnke University of Dundee,Prof. Pratima Murthy, National Institute of Mental Health & Neuro Sciences India,Dr. Rumana Haque ARK Foundation, Bangladesh,Dr. Helal Uddin Ahmed National Institute of Mental Health, Dhaka, Bangladesh University of York, UK
Impact The collaboration is multi-disciplinary and includes expertise from psychiatry, public health, epidemiology, physical and mental health comorbidity experts and health economists.
Start Year 2021
 
Description IMPASS 
Organisation University of York
Department Department of Health Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution Led the collaboration
Collaborator Contribution The following external collaborators contribute to the IMPASS project, Prof. Kamran Siddiqi , Dr. Helen Elsey, Dr. Hannah Jennings University of York,Prof. Saeed Farooq Keele University & Midlands Partnership NHS Foundation Trust, Prof. David McDaid London School of Economics & Political Science, Dr. Jan Boehnke University of Dundee,Prof. Pratima Murthy, National Institute of Mental Health & Neuro Sciences India,Dr. Rumana Haque ARK Foundation, Bangladesh,Dr. Helal Uddin Ahmed National Institute of Mental Health, Dhaka, Bangladesh University of York, UK
Impact The collaboration is multi-disciplinary and includes expertise from psychiatry, public health, epidemiology, physical and mental health comorbidity experts and health economists.
Start Year 2021
 
Description 23rd International Psychiatry Conference: Symposium on Mental & Physical Co Morbidity among Severe Mental Illness in South Asia 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact 23rd Psychiatry International Conference - 26 November 2022. IMPASS project was presented by one of our research team members(research assistant). The topic of the presentation was: Investigating the impact of COVID 19 and its response on people with severe mental illness in south AsiaThis conference provided the opportunity to showcase the research work to improve the current practice of mental health and well-being by focusing on developments and the latest trends in research.
Year(s) Of Engagement Activity 2022
 
Description WPA Thematic Congress 11th- 13th March,2022:Creating a Centre for Global Health Research & Development in a Low Middle Income Country How & Why 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact WPA thematic Congress is held annually to provide a global forum to mental health professionals, policymakers, patients, carers, regulatory body members and students. This conference gives an opportunity to discuss local learnings and experiences that might be translated and used in their own communities and to showcase the research work, disseminate results and develop an interest in future research work.
The presentation was given by the programme manager IMPASS. Topic: Overview of IMPASS project.
Year(s) Of Engagement Activity 2022