In the rural villages of the Sierra Madre region of Chiapas, women experiencing hardship show signs of emotional distress that are diagnosed as depression and anxiety by health professionals. In this study, we critically analyze the impact of a pilot mental health group intervention (Women’s Circles) facilitated by community mental health workers. The intervention consisted of eight structured sessions that included psychoeducation from a gender perspective, mindfulness exercises, interactive activities, arts and crafts, and sharing personal experiences. We carried out participant observation and 27 semi-structured interviews with the participants. The main outcomes were, first, that participants’ moods improved, and second, that the improvement was mainly due to gathering with others and having someone to talk to. In addition, we observed that lessons during the Circles were often prescriptive, which, rather than creating a space for reflection on personal experiences, imposed globalized views of mental health and gender. In sum, we describe both the positive impact this program had on mental well-being and the problematic spreading of psychoeducation.

Wearable technology and daily diaries offer insights into everyday behaviors that can further health research and treatment globally. However, the use of these methodologies outside of high-income settings has been limited. We conducted two pilot studies that enrolled 60 young women in the urban slums of Kampala, Uganda to understand design considerations associated with using wearable technology and daily diaries in this context. Each participant in the pilot studies was asked to wear a wearable activity tracker and complete daily diary questionnaires for 5 days. Based on our experiences, we identified several lessons that may be beneficial to others interested in implementing wearable technology and daily self-reports in their research and interventions, particularly when working in low-resource contexts. We discuss the importance of designing solutions tailored to the available resources, building validation for the most critical measures, investing in data management efforts and providing transparent and culturally accessible information to participants. Examples from our study are provided. These lessons may reduce the barriers and improve data quality for future researchers and practitioners interested in using these data collection methods globally.

Despite the recent momentum of mental health advocacy and resource allocation in several nations worldwide, the same progress is yet to be experienced in Haiti and other countries in the global south. In addition to the ongoing humanitarian crisis that continues to pre-dispose the people of Haiti to a variety of health conditions and mental illnesses, Haitian healthcare providers face further vulnerability to mental illness due to the high-stress nature of their work in a resource-limited environment. This study was conducted using a self-report questionnaire containing the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 screening tools, distributed to Haitian healthcare providers nationwide. The results revealed that 84% of the 106 participants experienced mild to severe symptoms of depression, while 69% reported mild to severe symptoms of anxiety. This study also found that social determinants, including community violence, economic and social instability, and poverty, are among the most detrimental contributing factors to the mental health of Haitian healthcare providers. Despite the acute need for support, 76% of participants also reported having either no awareness or no access to mental health support. These findings serve as an urgent call for action to improve access to mental health resources for Haitian healthcare providers.

The climate change crisis is a complex global challenge that has far- reaching implications for public health and well-being. Rising temperatures and more frequent extreme weather events are impacting physical health, mental well-being, and ecological balance. Vulnerable communities are disproportionately affected, especially in terms of food security. Furthermore, climate-related disasters have profound and lasting effects on mental health, leading to trauma responses and dissociation as coping mechanisms. This perspective delves into the concept of collective dissociation, a subconscious defense mechanism that hinders effective action in the face of the overwhelming climate crisis. Understanding and characterizing this phenomenon is essential to promote meaningful climate action. To combat collective dissociation and facilitate effective collective action, several strategies are proposed. Responsible information management for advocacy, local moral support, strategic policy development, and research on climate trauma processing are highlighted as vital approaches. By addressing the mental health implications of climate change, raising awareness, and prioritizing resilience and cooperation, societies can transcend collective dissociation and work together towards a more sustainable future for both the planet and its inhabitants. This call to action underscores the need for comprehensive and guided measures to safeguard planetary and population health in the face of this pressing crisis.

As part of the formative work of the SUCCEED Africa consortium, we followed a participatory process to identify existing gaps and resources needed for the development and implementation of a rights-based intervention for people with lived experience of psychosis in Malawi, Nigeria, Sierra Leone and Zimbabwe.

In 2021, we conducted a desk review of published and grey literature on psychosis in the four SUCCEED countries. Using an adapted version of the PRIME situation analysis template, data were extracted across the five domains of the WHO Community-Based Rehabilitation (CBR) Matrix: health, education, livelihoods, social and empowerment. This was supplemented with insights from personal communications with key stakeholders and the lived and professional experiences of team members.

Findings indicate that people with lived experience of psychosis have limited access to services and opportunities across the five CBR domains. Participation in social, religious, empowerment and political activities is restricted due to stigma and a lack of advocacy.

People with lived experience of psychosis in SUCCEED countries are not generally able to access support in line with essential components of CBR. There is a need for their greater inclusion in policy and advocacy activities.

The perspective article explores systemic issues in psychiatric care, particularly the barriers to timely treatment and the ethical dilemmas involved in involuntary interventions. It further examines the impact of anosognosia—lack of disease insight—on treatment, noting the difficulties in managing care for those unaware of their illness, and scrutinizes training materials from international organizations that might mislabel necessary psychiatric practices as human rights violations, thereby complicating the care landscape. The discussion extends to the legal and societal implications of psychiatric interventions, using Massachusetts’ Rogers Guardianship as a case study to highlight the consequences of legalistic approaches to mental health treatment.

The article calls for destigmatizing psychiatric treatment and integrating robust, evidence-based practices to improve patient outcomes and healthcare equity. The global mental health policy landscape is urged to recognize the critical role of psychiatric care in restoring health and dignity to individuals with serious mental illnesses, advocating for a more nuanced understanding and application of human rights in mental health.

In recent years the evidence base for psychological interventions in low- and -middle-income countries (LMIC) has rapidly accrued, demonstrating that task-shifting models result in desired outcomes. Next, it is important to look at how this evidence translates into practice. In doing so, this paper argues that the field of global mental health might benefit from applying a system theory or system science perspective. Systems thinking aims to understand how different components are connected and interdependent within a larger emergent entity. At present much of the research efforts into psychological interventions in LMIC are focusing on single interventions, with little focus on how these interventions sit in, or influence, a larger system. Adopting systems theory and system dynamics tools can help in; (i) better analyzing and understanding the key drivers of mental health problems and services, (ii) optimizing mental health services; and (iii) understanding the organization of people, institutions and resources required for rolling out and scaling-up mental health services. This paper reflects on some of these merits of a systems perspective, as well as provides some examples.

Commonly occurring mental health disorders have been well studied in terms of epidemiology, presentation, risk factors and management. However, rare or uncommon mental health disorders and events are harder to study. One way to do this is active surveillance. This article summarises how the Royal College of Psychiatrists Child and Adolescent Psychiatry Surveillance System was developed, as well as the key studies that have used the system and their impact, to make the case for a wider international surveillance unit for child and adolescent psychiatry. Keeping this surveillance active in different populations across the globe will add to existing knowledge and understanding of these uncommon disorders and events. This will in turn help in developing better frameworks for the identification and management for these disorders and events. It will also facilitate the sharing of ideas regarding current methodology, ethics, the most appropriate means of evaluating units and their potential applications.

Young refugees face numerous challenges before, during, and after their journey, leading to higher rates of mental health issues such as depression, anxiety, and posttraumatic stress disorder. These problems often remain untreated due to barriers like limited services, stigma, and varied distress expressions. One effective scalable intervention that bridges this treatment gap is problem management plus (PM+), a transdiagnostic program delivered by trained nonspecialists. However, PM+ lacks a module directly targeting posttraumatic stress, which is a common problem in young refugees. This study presents the cultural and contextual adaptation process of PM+ for young refugees in the Netherlands that includes a newly developed emotional processing module. Qualitative data collection included free list interviews with youngsters (n = 33), key informant interviews with professionals (n = 9), policymakers (n = 5), key people from communities (n = 10), focus group discussions (n = 11) and one focused interview. A new module targeting distressing memories was developed and reviewed by experts (n = 14). Results supported protocol adaptations, including culturally and age-appropriate language, examples, illustrations and length. This research aims to develop feasible, culturally sensitive mental health interventions tailored to the unique needs of young refugees.

Enhancing resilience is one way to prevent future mental illnesses and encourage recovery in the face of adversity. To develop and test the acceptability and feasibility (A&F) of a combined family and individual resilience intervention in two rural/semi-rural low-income settings in India and Kenya. We developed a five-session intervention including Life Skills Education (LSE) and a model of family resiliency. Among adolescents aged 14–16 years and their families in India and Kenya, we collected socio-demographics and audio records of delivery and undertook a process evaluation. Due to COVID-19, we developed a hybrid intervention. The facilitators and participants preferred the in-person model. India: Of 17 families, 10 fully completed the intervention. They identified three critical components: 1) story-telling, 2) cooperation and working together and 3) expressing feelings. Kenya: All 15 families completed the intervention. Critical elements were 1) seeing social value in learning to make good decisions, 2) promoting an optimistic view of life, 3) hearing stories that resonated with their situation and 4) enhancing family performance through knowledge-building. We mapped the active ingredients, showing fidelity and acceptability. The intervention showed promising A&F parameters. Flexibility and local adaptation were important for delivery.

Feb. 19, 2024.

Young people (YP) (between 10 and 24 years) are disproportionally vulnerable to developing and being affected by mental health conditions due to physical, social and emotional risk factors. YP in low-and middle-income countries (LMICs) have poorer access to, and quality of, mental health services compared to those in high-income countries. Digital mental health interventions (DMHIs) have been proposed as tools to address this burden of disease and reduce the global treatment gap in youth mental health outcomes. This study aimed to examine the evidence for DMHIs for treating mental disorders in YP based in LMICs. To do this, the author searched academic databases (MEDLINE, PsycINFO, Embase and Web of Science) for primary studies on DMHIs targeting YP in LMICs. Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria were followed. The quality of the studies was assessed using the Critical Appraisal Skills Programme) framework. A narrative synthesis methodology was used to summarise and explain the findings. The authors identified 287 studies of which 7 were eligible in the final review. The authors found evidence of the effectiveness of multiple forms of DMHI (especially internet-based cognitive behavioural therapy) on anxiety and depression outcomes. Studies reported a lack of long-term benefits of treatment, high dropout rates, and did not include key geographical settings or data on cost-effectiveness. No studies were judged to be of high quality. This review highlights the available evidence showing that DMHIs can improve mental health outcomes for YP in LMICs, but due to the limited number of studies and lack of high-quality data, increased adoption and scaling up of digital interventions require more rigorous studies showing clinical effectiveness and ability to provide return on investment.

Impactful research on refugee mental health is urgently needed. To mitigate the growing refugee crisis, researchers and clinicians seek to better understand the relationship between trauma, grief and post-migration factors with the aim of bringing better awareness, more resources and improved support for these communities and individuals living in host countries. As much as this is our intention, the prevailing research methods, that is, online anonymous questionnaires, used to engage refugees in mental health research are increasingly outdated and lack inclusivity and representation. With this perspective piece, we would like to highlight a growing crisis in global mental health research; the predominance of a Global North-centric approach and methodology. We use our recent research challenges and breakdowns as a learning example and possible opportunity to rebuild our research practice in a more ethical and equitable way.

Mental health conditions, recognised as a global crisis, were further exacerbated by the COVID-19 pandemic. Access to mental health services remains limited, particularly in low-income regions. Task-sharing interventions, exemplified by Problem Management Plus (PM+), have emerged as potential solutions to bridge this treatment gap. This study presents an evaluation of the PM+ scale-up in Sub-Saharan Africa (Ethiopia and Benin) and Eastern Europe (Croatia and Bosnia and Herzegovina) as part of a mental health and psychosocial support programming including 87 adult participants. A mixed-method approach assesses the impact of the intervention. Quantitative analyses reveal significant reductions in self-reported problems, depression, anxiety and improved functioning. Qualitative data highlight four main themes: general health, family relationships, psychosocial problems and daily activities. These thematic areas demonstrate consistent improvements across clients, irrespective of the region. The findings underscore the impact of PM+ in addressing a broad spectrum of client issues, demonstrating its potential as a valuable tool for mitigating mental health challenges in diverse settings. This study contributes to the burgeoning body of evidence supporting PM+ and highlights its promise in enhancing mental health outcomes on a global scale, particularly for vulnerable populations.