Title: Psychosis Recovery Orientation in Malawi by Improving Services and Engagement (PROMISE)
Funder: Wellcome Trust

Abstract: Malawi has a population of around 19 million people, projected to double by 2042, and is one of the world’s poorest nations. Severe mental illness is managed by a very small number of staff in two specialist hospitals, aided by clinical officers in general hospitals and clinics. Ministry of Health plans announced in 2001 to integrate mental health care into primary care are yet to be implemented. Consequently, psychosis is largely undetected and untreated, and the average duration of untreated psychosis (DUP) is as long as 6 years. We propose to develop psychosis detection and management systems to increase psychosis awareness, reduce DUP and improve outcomes in Malawi. We will use the MRC framework for developing and evaluating complex interventions, augmented by Theory of Change and Participatory Action Research approaches. Deliverables include a validated psychosis screening tool, to facilitate detection by Health Surveillance Assistants (HSAs) at village level, and a simple management blueprint encompassing education and community supports, with an integrated care pathway including primary health centre clinics and District Mental Health Teams. People with lived experience (PWLE) and caregivers will be closely involved throughout to steer the development of tools and interventions. This sustained and analytic attention to lived experience will ensure that these initiatives are acceptable to and, vitally, shaped by the communities concerned, and will interface with broader health, social and family support systems. The effect of these interventions will be assessed in terms of DUP, symptom remission, functional recovery, quality of life and caregiver impact.

Lay abstract: Malawi has a population of around 19 million people, projected to double by 2042, and is one of the world’s poorest nations. Severe mental illness is managed by a very small number of staff in two specialist hospitals, aided by clinical officers in general hospitals and clinics. Ministry of Health plans announced in 2001 to integrate mental health care into primary care are yet to be implemented. Consequently, psychosis is largely undetected and untreated, and the average duration of untreated psychosis (DUP) is as long as 6 years. We propose to develop psychosis detection and management systems to increase psychosis awareness, reduce DUP and improve outcomes in Malawi. We will use the MRC framework for developing and evaluating complex interventions, augmented by Theory of Change and Participatory Action Research approaches. Deliverables include a validated psychosis screening tool, to facilitate detection by Health Surveillance Assistants (HSAs) at village level, and a simple management blueprint encompassing education and community supports, with an integrated care pathway including primary health centre clinics and District Mental Health Teams. People with lived experience (PWLE) and caregivers will be closely involved throughout to steer the development of tools and interventions. This sustained and analytic attention to lived experience will ensure that these initiatives are acceptable to and, vitally, shaped by the communities concerned, and will interface with broader health, social and family support systems. The effect of these interventions will be assessed in terms of DUP, symptom remission, functional recovery, quality of life and caregiver impact.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH