The ‘IMPACT in South Asia’ programme was funded by the National Institute for Health and Care Research. The group includes researchers, clinicians, policy makers and patient and public representatives from partners in Bangladesh, India, Pakistan and the UK.
The aim of the programme was to work together with all key stakeholders to tackle the challenge of mental and physical multimorbidity. This affects some of the poorest and most vulnerable people in low and middle income countries. The Group’s goals were to improve health and reduce deaths associated with diabetes, heart and lung diseases in people with severe mental illness (SMI) (i.e. schizophrenia and bipolar disorder). And to reduce depression and anxiety in people with chronic physical health conditions. The Group also aimed to build research capacity for applied health research on multimorbidity.
Mental and physical multimorbidity
People with SMI die around 20 years earlier than the general population. This is mainly because of preventable chronic physical disorders. There are many reasons for this. The higher prevalence of health risk behaviours such as smoking, physical inactivity, poor diet and alcohol contributes. So does the additional challenge of getting good care for physical health problems in the presence of a mental disorder. And the treatments for mental illnesses may also increase the risk of obesity and diabetes.
Around 30% of those with a chronic physical disorder also have depression or anxiety. These conditions often go undetected and untreated. And they are known to worsen outcomes for physical illness. The coexistence of mental and physical illness is a major and growing problem, particularly in South Asia, and it affects some of the poorest and most vulnerable people.
With collective multidisciplinary research and clinical expertise, and the knowledge and understanding our partners brought about health systems and social, political and cultural contexts in Bangladesh, India and Pakistan, the IMPACT programme, was in an excellent position to tackle these challenges.
The IMPACT programme included several feasibility studies, preparing the way for large-scale research programmes; visit our Research Studies page for further information on these. Preliminary work carried by the IMPACT Group was key to securing other funding. The NIHR RIGHT DiaDeM programme and the TB Multimorbidity project both address mental and physical multimorbidity and are built on findings and collaborations from the original IMPACT Group.
Patient, community and public involvement
To ensure the programme kept a clear focus on the needs of people with mental and physical multimorbidity, the Group put patient, community and public engagement at the heart of all it’s research. Each study had a Community Advisory Panel (CAP). The panel included patients, carers and supporters, and community representatives. The role of the CAP was to advise on the design of the studies and interventions.
Another priority for the IMPACT in South Asia programme was capacity development. The focus was on developing research methods, research management and research leadership skills. The aim was to build world-class research teams in low and middle income countries, so providing a platform for securing large-scale grants to address the critical lack of evidence on effective interventions for mental and physical multimorbidity.