Severe mental disorders are major health burden worldwide with a large treatment gap in low- and middle- income countries (LMICs) in South Eastern Europe. Policymakers, planners and professional bodies in these countries are committed to closing the treatment gap; however they struggle to overcome basic obstacles such as funding difficulties and lack of qualified staff. IMPULSE aims to facilitate the development of effective community-based mental health care in these countries by implementing an evidence-based, easily deliverable, affordable and cost-saving intervention called DIALOG+. The intervention is a technology-assisted and based on patient-centred communication, quality of life research and solution-focused therapy. It was designed to make routine meetings between clinicians and patients structured, comprehensive and more therapeutically effective. DIALOG+ is effective in reducing clinical symptoms, improving quality of life and reducing treatment costs. IMPULSE brings together a multi-disciplinary Consortium (experts in psychiatry, psychology, implementation science, health economy and transcultural research) to conduct a mixed method, multiple case implementation study across five LMICs - Bosnia and Herzegovina, Kosovo, Former Yugoslav Republic of Macedonia, Montenegro, and Serbia. IMPULSE will formulate contextually appropriate approach and optimise delivery of this intervention across different healthcare systems, thus exploring how local, organisational and national factors influence adoption, implementation, sustainability and economic costs. This process will generate new knowledge on how to best develop and organise community mental health care in LMICs through the implementation of effective and generic interventions. We will undertake a series of activities to widely disseminate IMPULSE results to maximise the impact of the research. This will include translating the findings into national implementation guidance and policies in each country.

For nearly 900 million people living in Europe, mental disorders constitute the most significant yet most neglected public health problem: depression affects an estimated 30.3 million Europeans, snf psychotic disorders 5 million Europeans. People with severe and enduring mental ill health want the same things out of life as other citizens but are often placed in a vulnerable position and are hence afforded less opportunities to attain their goals and thus experience a lower quality of life, and have a lower life expectancy compared to the general population. For many countries that have undergone mental health services reform or have health systems in transition, efforts to make such comprehensive community-based mental health services available resulted in short-lived outcomes or are still to demonstrate substantial impact. RECOVER-E’s aims to ensure well-functioning community mental health teams in 5 countries in Europe (Macedonia, Romania, Bulgaria, Croatia, and Montenegro), which will serve as the central node for coordination and provision of care for people with SMI. Our project narrows the implementation gap by going beyond infrastructure changes and pursuing the development of human resource capacity and care pathways that can be distilled in a comprehensive pathway to scale for regional and national decision-makers for uptake after the project’s life span. RECOVER-E will: 1) Develop evidence based care pathways and treatment protocols for transition to scale for regional and national decision makers in 5 implementation sites; 2) Establish a peer to peer capacity building partnership in community mental health by linking a European expert panel with key stakeholders in 5 implementation sites to co-create community mental health services for people with SMI) 3) Evaluate intervention elements that will enhance sustainable adoption and implementation of community-based mental health care for people with SMI, by carrying out implementation research.