Adolescents face increased vulnerability to mental health conditions, particularly when exposed to multidimensional poverty and trauma and pronounced treatment gaps. Waves for Change, a Sport for Development (SfD) intervention, employs task-sharing through its ‘5-Pillar Method’ to build resilience and prevent mental health conditions among at-risk adolescents in South Africa. This study assessed the implementation outcomes of this Method using a mixed-methods design, incorporating interviews, focus groups, self-report questionnaires, document reviews and routine site assessments, with 69 stakeholders including staff, peer coaches, mental healthcare providers, social workers, teachers, and adolescents. A thematic analysis revealed key facilitators to successful implementation, including: a year-long preventative approach, creation of safe spaces for learning self-regulation skills, employment of youth coaches from local communities, incorporation of fun, group-based physical activities, modelling and repetition of desired skills, provision of transport and meals, government partnerships, and consistent weekly training and supervision. Implementation challenges included coach capacity, due to their education levels and own trauma experiences, measurement of fidelity to the Method and of adolescents’ emotional experiences, and some concerns around ocean safety. These findings provide valuable insights for implementing community-based SfD interventions for adolescents facing adversity, and contributes towards global evidence supporting task-shared mental health approaches in LMICs.

Indigenous peoples across the world are at disproportionate risk of mental health problems. Colonial hegemony, cultural infiltration, language loss, land grabbing, limited access to healthcare services, including mental health, and geographical isolation – all in synergy – contribute to the heightened risk of developing mental health problems. Epistemic injustice, apparently unrelated, yet another major determinant – can also contribute to the higher prevalence of mental health problems among Indigenous peoples. Systemic exclusion and marginalization of Indigenous people from the generation, dissemination, and validation of knowledge – the central concept of epistemic injustice – provides an opportunity to reflect on the disproportionate rates of mental health problems. If epistemic injustice is left unaddressed, the impetus for Indigenous peoples to participate in conventional health practices would be greatly impeded. In this article, I present the case of Bangladesh, where the conventional mental healthcare system has historically been ignorant of the inclusion of Indigenous people’s perspectives and lived experiences, eventually perpetuating epistemic injustice. Finally, I provide a framework to address epistemic injustices to reform mental healthcare in Bangladesh that can inform a system equipped with equitability, accessibility, cultural sensitivity, human rights, social justice, and collaborative alliance – key tenets of global mental health.

Worldwide, research has demonstrated that maternal experiences of violence can adversely affect infant development, but moderating and mediating effects on this pathway are less understood, particularly within low- and middle-income countries. Using longitudinal structural equation modeling, the present study analyzed data from 251 Peruvian mothers during the prenatal and postpartum periods. We evaluated the relations between mothers’ experiences of childhood violence (CV), prenatal intimate partner violence (IPV), posttraumatic stress symptoms (PTSS), and resilience, and how these factors influenced domains of their infants’ temperament (i.e., surgency, negative affectivity, and regulatory capacity). Consistent with hypotheses, analyses revealed that mothers’ CV exposure was associated with increased prenatal IPV and PTSS, and prenatal IPV was linked to increased prenatal PTSS and lower resilience. Prenatal PTSS was linked to lower infant regulatory capacity. Maternal prenatal resilience was negatively associated with prenatal PTSS. High postpartum maternal resilience mitigated the adverse effects of maternal CV on infant regulatory capacity. Inconsistent with hypotheses, postpartum PTSS was associated with higher infant regulatory capacity, though sensitivity testing suggested this finding may be spurious. Findings underscore the need for violence prevention and prenatal mental health interventions to reduce maternal PTSS and bolster resilience to support positive infant outcomes in Peru.

Mobile health (mHealth) platforms have the potential to increase access to evidence-based interventions in low-resource settings. This study applied a user-centered design (UCD) approach to develop and evaluate an mHealth supervision tool for community health workers (CHWs) delivering an early childhood development intervention in rural Sierra Leone. We engaged CHWs (N=8) and supervisors (N=4) in focus group discussions, user testing sessions and exit interviews to gather feedback on the mHealth supervision tool’s usability and acceptability. Mixed methods findings indicated that the tool was generally well-received and perceived as easy to use, but there were also challenges related to connectivity, phone charging and the need for more comprehensive training and support. Overall, this study suggests that a UCD approach can promote the usability of mHealth tools to support CHWs in delivering evidence-based interventions in low-resource settings, highlighting the importance of addressing contextual challenges and providing adequate training and support to ensure the effectiveness and sustainability of such tools.

Task-shared psychological treatments play a critical role in addressing the global mental health treatment gap, yet their integration into routine care requires further study. This study evaluated the causal association between an implementation factor of a task-shared psychological treatment and participant outcomes to strengthen the implementation-to-outcome link within global mental health. This secondary analysis utilized cohort data from the Program for Improving Mental Health Care (PRIME) implemented in Sehore, India where trained non-specialist health workers delivered treatment for depression and alcohol use disorder (AUD). Propensity scores and inverse probability of treatment weights examined the impact of mental health service users’ treatment attendance on users’ symptom severity (PHQ-9 scores for depression; AUDIT scores for AUD) at 3 and 12-month follow-ups. Among the 240 patients with depression, higher treatment session attendance led to 1.3 points lower PHQ-9 scores (vs. no attendance) and 2.4 points lower PHQ-9 scores (vs. low attendance) at 3 months, with no significant effects at 12 months. Among the 190 AUD patients, treatment session attendance did not have a significant impact on AUDIT scores. Our findings have implications for enhancing treatment session attendance among those with depression within task-shared psychological treatments.

This paper aims to give an overview of child and adolescent mental health services (CAMHS) in Aotearoa New Zealand. We provide a brief overview of the demographics of the country and include the most up-to-date epidemiological data on child and adolescent mental health. To meet these psychiatric needs, we consider the present workforce, governance, funding and structure of CAMHS. Current psychiatric practice is heavily influenced by the country's unique history and cultural mix. Aotearoa New Zealand is noted for outstanding epidemiological research.

Most people with mental illness in low and middle-income countries (LMICs) do not receive biomedical treatment, though many seek care from traditional healers and faith healers. We conducted a qualitative study in Buyende District, Uganda, using framework analysis. Data collection included interviews with 24 traditional healers, 20 faith healers, and 23 biomedical providers, plus 4 focus group discussions. Interviews explored treatment approaches, provider relationships, and collaboration potential until theoretical saturation was reached. Three main themes emerged: (1) Biomedical providers’ perspectives on traditional and faith healers; (2) Traditional and faith healers’ views on biomedical providers; and (3) Collaboration opportunities and barriers. Biomedical providers viewed faith healers positively but traditional healers as potentially harmful. Traditional and faith healers valued biomedical approaches while feeling variably accepted. Interest in collaboration existed across groups but was complicated by power dynamics, economic concerns, and differing mental illness conceptualizations. Traditional healers and faith healers routinely referred patients to biomedical providers, though reciprocal referrals were rare. The study reveals distinct dynamics among providers in rural Uganda, with historical colonial influences continuing to shape relationships and highlighting the need for integrated, contextually appropriate mental healthcare systems.

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.