Ikkos & Bouras offer an interesting analysis of the failure of the community psychiatry approach to achieve its original goals in high-income countries such as the USA and UK.^{Reference Ikkos and Bouras1} They accurately identify how factors such as neoliberal policies, globalisation and digital technology have drastically altered the societal landscape on which the concept of ‘community’ was originally based.

A historical approach shows that mental health services cannot be separated from underlying structural economic problems. In high-income countries, these policies often ignore socioeconomic inequalities, further exacerbating the mental health conditions of communities.^{Reference McAllister, Fritzell, Almroth, Harber-Aschan, Larsson and Burström2} For example, mental health policies in the USA and UK often focus more on individuals and medical treatment than on understanding the social and economic roots of mental health problems.^{Reference Callaghan, Fellin and Warner-Gale3} This has led to ineffectiveness in addressing broader issues such as poverty, unemployment and social marginalisation.^{Reference Sylvestre, Notten, Kerman, Polillo and Czechowki4}

The updated interpretation of metacommunity proposed by Ikkos & Bouras¹ provides a useful framework for understanding this transformation and highlights the need for psychiatrists and other mental health providers to adopt socially critical thinking and active engagement in the public sphere.^{Reference Leibold, Holyoak, Mouquet, Amarasekare, Chase and Hoopes5} Globalisation and social media have created ‘new communities’ that differ from the notion of geographically based communities that underlie community psychiatry. These virtual communities, while offering emotional and informational support, are often unable to replace the physical and social support provided by locally based communities – as evidenced by numerous studies on social solidarity, counselling services for female victims of bullying, and trauma healing based on local wisdom in the aftermath of natural disasters.^{Reference Sayuti, Taqiuddin, Evendi, Hidayati and Muttaqin6–Reference Merry9}

In this context, psychiatrists and mental health service providers in high-income countries need to adopt a more holistic and democratic approach to their practice.^{Reference Semrau, Alem, Ayuso-Mateos, Chisholm, Gureje and Hanlon10} We agree that to address broader structural challenges, such as socioeconomic inequality, we need a ‘democratic psychiatry’ that challenges these root causes and ensures equitable access to quality mental health services.^{Reference Solt11} Democratic psychiatry should involve patients, families and communities in decision-making and challenge policies that reinforce social and economic inequities.^{Reference Zisman-Ilani, Lysaker and Hasson-Ohayon12}

However, in low- and middle-income countries, the challenges of providing adequate mental health services are often more complex and urgent. Therefore, we propose the inclusion of perspectives from low- and middle-income countries that face different challenges in providing mental health services.^{Reference Wainberg, Scorza, Shultz, Helpman, Mootz and Johnson13} For example, in many such countries, mental health services are often underfunded and deprioritised in national health systems. Other challenges include stigma towards mental illness, lack of trained mental health personnel and limited access to care.