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

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.

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.