Participatory mental health interventions in low-income and middle-income countries: a realist review protocol

Abstract

IntroductionThe launch of the Movement for Global Mental Health brought long-standing calls for improved mental health interventions in low-and middle-income countries (LMICs) to centre stage. Within the movement, the participation of communities and people with lived experience of mental health problems is argued as essential to successful interventions. However, there remains a lack of conceptual clarity around ‘participation’ in mental health interventions with the specific elements of participation rarely articulated. Our review responds to this gap by exploring how ‘participation’ is applied, what it means and what key mechanisms contribute to change in participatory interventions for mental health in LMICs.Methods and analysisA realist review methodology will be used to identify the different contexts that trigger mechanisms of change, and the resulting outcomes related to the development and implementation of participatory mental health interventions, that is: what makes participation work in mental health interventions in LMICs and why? We augment our search with primary data collection in communities who are the targets of global mental health initiatives to inform the production of a programme theory on participation for mental health in LMICs.Ethics and disseminationEthical approval for focus group discussions (FGDs) was obtained in each country involved. FGDs will be conducted in line with WHO safety guidance during the COVID-19 crisis. The full review will be published in an academic journal, with further papers providing an in-depth analysis on community perspectives on participation in mental health. The project findings will also be shared on a website, in webinars and an online workshop.

Contingent universality: The epistemic politics of global mental health

“…In fact, the very idea of generalizable evidence today may be less challenged by social scientists than by novel RCT designs and realist evaluation methods, which no longer aim to produce universal and transferrable ‘proof of concept’ evidence but to answer to question: ‘What works, for whom, where, and why?’ (Heap et al, 2022). For example, sequential, multiple assignment, randomized trials (SMART) create iterative and adaptive interventions that get optimized along the way by switching participants from one group to another at different stages, which produces knowledge on the relative effectiveness of multiple intervention options, as well as aggregate profiles of the kind of people who would benefit from an intervention (Breuer et al, 2018; Maulik et al, 2015; Mukherjee et al, 2022).…”

A Protocol for a Rapid Realist Review of Literature Examining Co-Production in Youth Mental Health Services

“…Despite the problem of definitional slippage of the concept of "co-production" and the problem of cobiquity (a rise of different 'co' words describing collaborative practices) [23], there is some agreement in the literature on definitions. Heap et al [28] identify how different theorists repeatedly conceptualised degrees of participation as ladders or continuums with differences in terminology but which all range from "consumerism" to "democratisation." On these various scales, service users have little power or tokenistic participation at the bottom (consumerism), and at the top they are in control or share control (democratisation).…”

Working in the wake: transformative global health in an imperfect world

“…But there is limited acknowledgement of the political and power dimensions at work within participatory approaches. Recently, along with colleagues, 17 we reviewed definitions of participation used within the development and global health landscape. We identified that most paradigms view participation as working to contribute to change through process, or outcome.…”