Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study
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AIMS: The aims of this paper are to: (i) explore the experiences of involvement of mental health service users, their caregivers, mental health centre heads and policy makers in mental health system strengthening in three low- and middle-income countries (LMICs) (Ethiopia, Nepal and Nigeria); (ii) analyse the potential benefits and barriers of such involvement; and (iii) identify strategies required to achieve greater service user and caregiver participation. METHODS: A cross-country qualitative study was conducted, interviewing 83 stakeholders of mental health services. RESULTS: Our analysis showed that service user and caregiver involvement in the health system strengthening process was an alien concept for most participants. They reported very limited access to direct participation. Stigma and poverty were described as the main barriers for involvement. Several strategies were identified by participants to overcome existing hurdles to facilitate service user and caregiver involvement in the mental health system strengthening process, such as support to access treatment, mental health promotion and empowerment of service users. This study suggests that capacity building for service users, and strengthening of user groups would equip them to contribute meaningfully to policy development from informed perspectives. CONCLUSION: Involvement of service users and their caregivers in mental health decision-making is still in its infancy in LMICs. Effective strategies are required to overcome existing barriers, for example making funding more widely available for Ph.D. studies in participatory research with service users and caregivers to develop, implement and evaluate approaches to involvement that are locally and culturally acceptable in LMICs.
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Mental disorders are non-communicable diseases.
“that mental disorders are in fact non-communicable diseases”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [101]
Treatment of people with mental disorders is an indivisible constituent of universal health coverage.
“that the treatment of people with mental disorders is an indivisible constituent of universal health coverage.”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [101]
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- Authors
- Lempp, H., Abayneh, S., Gurung, D., Kola, L., Abdulmalik, J., Evans-Lacko, S., Semrau, M., Alem, A., Thornicroft, G., & Hanlon, C.
- Affiliations
- King's College London (GB)
- Addis Ababa University (ET)
- University of Ibadan (NG)
- Corresponding author
- Lempp, H.
- ORCID
- Venue
- Epidemiology and Psychiatric Sciences
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017-11-08
- Volume
- 27
- Issue
- 1
- Pages
- 29-39
- ISSN
- 2045-7960 (ISSN-L)
- 2045-7979
- PMC
- PMC6998885
- OpenAlex
- W2767781105
- Cited by
- 135
- References
- 51
- Citations by year
- 2026: 2 · 2025: 10 · 2024: 13 · 2023: 14 · 2022: 18 · 2021: 45 · 2020: 15 · 2019: 11 · 2018: 5 · 2017: 2
- FWCI
- 14.58
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Epidemiology and Psychiatric Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, cc-by)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
- London School of Economics and Political Science Theses Online (London School of Economics and Political Science) (acceptedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- Greater South Information System
- Funders
- National Institute for Health and Care Research
- European Commission
- Topics
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- service user involvement, caregiver involvement, mental health system strengthening, mental health policy, low- and middle-income countries, stigma, poverty, barriers to participation, mental health promotion, user empowerment, participatory research, Ethiopia, Nepal, Nigeria
- MeSH terms
- Mental Disorders, Cross-Sectional Studies, Developing Countries, Female, Health Personnel, Health Services Accessibility, Humans, Interviews as Topic, Male, Mental Health, Mental Health Services, Patient Acceptance of Health Care, Patient Participation, Poverty, Primary Health Care, Caregivers, Qualitative Research
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