Background and rationale {6a}
long-term psychosis, SMI, psychosis
Severe mental illness (SMI) presents a major challenge worldwide, affecting approximately 5–8% of the world’s population [The prevalence of mental health conditions in Pakistan is reportedly up to 34% [Resource scarcity within healthcare systems in LMICs has led to calls for more stringent priority setting and allocation of available resources to ensure the most effective use. In high-income countries (HICs), evidence on the cost-effectiveness of innovative approaches to manage mental health conditions is routinely generated to inform policy makers. Studies in HICs confirm that community management of psychosis represents the best value for money and can result in future resource savings for the healthcare system [A large proportion of people with psychosis in India and Pakistan live with their families as there are limited alternatives and welfare support [This RCT sits in a wider programme of research, the PIECEs project, which aims to improve community services for people with long-term psychosis by adapting, testing and implementing a low-cost, approach called DIALOG+. The programme and RCT is being conducted in two urban cities: Karachi, Pakistan and Chennai, India. Approaches to community care shown to be effective here will have a high chance of success in other sites across the Indian subcontinent and, if successful, there is potential to improve community-based care and the QoL for millions of people within India and Pakistan who experience psychosis.Previous research developed DIALOG+ which is an evidence-based approach to improve the quality of care for people with long-term psychosis, by utilising the existing resources available to patients within their families, community and healthcare services. DIALOG+ is a novel technology-assisted and resource-oriented intervention that is based on QoL research, concepts of patient-centred communication, IT developments and solution-focused therapy [