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Service user involvement in global mental health

what have we learned from recent research in low and middle-income countries?

Ryan, Grace K.a; Semrau, Mayab; Nkurunungi, Eddiec; Mpango, Richard S.d

Current Opinion in Psychiatry: July 2019 - Volume 32 - Issue 4 - p 355–360
doi: 10.1097/YCO.0000000000000506
PROVISION OF SERVICES TO PEOPLE WITH MENTAL ILLNESS: Edited by Giovanni de Girolamo and Thomas Becker

Purpose of review The Lancet Commission on global mental health and sustainable development claims the field of global mental health is undergoing a ‘transformational shift’ toward an ethic of ‘nothing about us without us’. Yet a systematic review published in 2016 identified few examples of meaningful participation by service users in mental health systems strengthening in low and middle-income countries (LMICs). To investigate whether this is still the case, we conducted a rapid review of primary research published between June 2017 and December 2018.

Recent findings We identified 10 studies reporting on user involvement in LMICs, including three in mental health policy and planning, three in mental health services or capacity-building and three in treatment decision-making. An additional study was identified as having involved users in data collection, although this was unclear from the original text. Included studies were mostly qualitative and conducted as part of a situation analysis, pilot study, or other formative research. Few reported the results of efforts to improve involvement, suggesting this shift remains at an early stage.

Summary Although the number of studies published on user involvement is rapidly increasing, the potentially ‘transformational’ effects of this shift in global mental health are not yet being felt by most users in LMICs.

aDepartment of Population Health, London School of Hygiene and Tropical Medicine, London

bGlobal Health and Infection Department, Brighton and Sussex Medical School, Brighton, UK

cButabika Recovery College, Butabika National Referral Hospital, Kampala, Uganda

dOccupational Therapy Department, Butabika National Referral Hospital, Kampala

Correspondence to Grace K. Ryan, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Tel: +44 0 2072994660; e-mail:

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