About the project
IMPULSE (Implementation of an effective and cost-effective intervention for patients with psychotic disorders in low and middle-income countries in South Eastern Europe) is a project funded by the European Commission and GACD as part of the Horizon 2020 initiative. The main goal of the project is to improve treatment of individuals diagnosed with psychotic disorders in five low and middle income countries of Southeast Europe: Bosnia and Herzegovina, Kosovo *UN Resolution, Republic of North Macedonia, Montenegro, and Serbia. The project also focuses on bridging the gap between research and policy, facilitating community-based mental health care, facilitating user-led involvement, and building research capacity in the participating countries. The IMPULSE project has received 2.4 million EUR to conduct research activities over three years, starting in April 2018. Due to the COVID-19 pandemic some research activities have been delayed and the team has requested a non-cost 6-month extension. If granted by the funder the study will end in September 2021.
Why was IMPULSE created?
Severe mental disorders such as psychotic disorders affect 3-5% of the population. The signs can vary, but often include hearing voices, not being able to understand what is real and what is not, thinking that family or friends are part of a conspiracy to harm the patient, changing and sometimes very low mood, and social and emotional withdrawal. Stigma, discrimination and violation of human rights of people with psychotic disorders are common. Psychotic disorders typically last for decades and present a major health, social, and economic burden for patients, families, caregivers, and the wider society. Psychotic disorders have a particularly large treatment gap in low- and middle- income countries in Southeast Europe where up to 50% of affected people do not receive care for their condition. This fosters further social exclusion and inequality of this vulnerable group. Current treatment guidelines for psychotic disorders suggest combined-therapy approach including antipsychotic medication, psychological therapy and family support. In reality the implementation of these guidelines in the participating countries is problematic and most people are treated mainly with medication in hospital-based settings. IMPULSE was created to improve psychosocial aspect of treatment of individuals with psychotic disorders. This will be achieved by working collaboratively with all relevant stakeholders including patients, carers, clinicians and policy makers to test and implement an already existing digital mental health intervention called DIALOG+. DIALOG+ represents an affordable and effective intervention which has already demonstrated positive outcomes in previous research.
What does IMPULSE involve?
At the beginning of the project we conducted a series of interviews and focus groups with patients, families, clinicians and other stakeholders to better understand how to implement the DIALOG+ intervention in each country. We also analysed treatment guidelines and relevant policy documents in each country to better understand issues that are specific to that location. Patients already have routine meetings with their clinicians, often to discuss their medication. This study involves the use of the DIALOG+ intervention during these routine clinical visits, so that patients themselves can decide which aspects of their life that they would like to discuss and work on improving. DIALOG+ invites them to rate 12 domains that are related to mental health, physical health, relationships and employment. Patient decides which of these they would like to discuss in detail during the meeting. There is then a 4-step approach to help improve this aspect of their life. These meetings will take place at different time points across one year. In each participating country, researchers from the IMPULSE project will collect information about demographic characteristics, quality of life, and symptoms in patients taking part to the project through the administration of questionnaires and clinical scales. This will be in the form of a randomised-controlled clinical trial focused on the effectiveness and cost-effectiveness of the intervention compared to treatment as usual (aim 1) and the implementation of the intervention (aim 2). Two advisory panels, one composed of patients and caregivers, and the other composed of clinicians, policy makers and service providers were set up in each country at the beginning of the project to provide input related to research activities, dissemination, sustainability and scaling up. An independent Scientific Advisory Board provides independent feedback and reviews the project.
- Advancing implementation of affordable mental health interventions to alleviate burden of severe mental disorders in low- and middle- income countries
- Facilitating the development of effective community-based mental health care
- Empowering patients and caregivers and facilitating user-involvement in research
- Building/strengthening research capacity
The IMPULSE Consortium
The Consortium includes nine partners from six countries; they represent a mixture of academic institutions and user-led organisations:
- Queen Mary University of London, United Kingdom (leading organisation)
- Clinical Center of University of Sarajevo, Bosnia and Herzegovina
- University Clinic of Psychiatry – Skopje, North Macedonia
- University of Pristina “Hasan Prishtina”, Kosovo* UN Resolution
- Psychiatric Clinic in Podgorica, Montenegro
- Faculty of Medicine (University of Belgrade), Belgrade, Serbia
- CITY University of London, United Kingdom
- User-led organisation Menssana, Sarajevo, Bosnia and Herzegovina
- User-led organisation Prostor, Belgrade, Serbia