title: Developing a holistic policy and intervention framework for global mental health.
abstract: BACKGROUND
  There are significant gaps in the accessibility and quality of mental health services around the globe. A wide range of institutions are addressing the challenges, but there is limited reflection and evaluation on the various approaches, how they compare with each other, and conclusions regarding the most effective approach for particular settings. This article presents a framework for global mental health capacity building that could potentially serve as a promising or best practice in the field. The framework is the outcome of a decade of collaborative global health work at the Centre for Addiction and Mental Health (CAMH) (Ontario, Canada). The framework is grounded in scientific evidence, relevant learning and behavioural theories and the underlying principles of health equity and human rights.
  
  
  METHODS
  Grounded in CAMH's research, programme evaluation and practical experience in developing and implementing mental health capacity building interventions, this article presents the iterative learning process and impetus that formed the basis of the framework. A developmental evaluation (Patton M.2010. Developmental Evaluation: Applying Complexity Concepts to Enhance Innovation and Use. New York: Guilford Press.) approach was used to build the framework, as global mental health collaboration occurs in complex or uncertain environments and evolving learning systems.
  
  
  RESULTS
  A multilevel framework consists of five central components: (1) holistic health, (2) cultural and socioeconomic relevance, (3) partnerships, (4) collaborative action-based education and learning and (5) sustainability. The framework's practical application is illustrated through the presentation of three international case studies and four policy implications. Lessons learned, limitations and future opportunities are also discussed.
  
  
  CONCLUSIONS
  The holistic policy and intervention framework for global mental health reflects an iterative learning process that can be applied and scaled up across different settings through appropriate modifications.
authors.affiliation: Office of Transformative Global Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Akwatu
authors.initials: A
authors.lastname: Khenti
authors.affiliation: Office of Transformative Global Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, Health System Strategy and Policy Division, Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada.
authors.forename: Stéfanie
authors.initials: S
authors.lastname: Fréel
authors.affiliation: Office of Transformative Global Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: Trainor
authors.affiliation: Office of Transformative Global Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, Health System Strategy and Policy Division, Ontario Ministry of Health and Long-Term Care, Toronto, Ontario, Canada.
authors.forename: Sirad
authors.initials: S
authors.lastname: Mohamoud
authors.affiliation: Office of Transformative Global Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada and.
authors.forename: Pablo
authors.initials: P
authors.lastname: Diaz
authors.affiliation: Office of Transformative Global Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Erica
authors.initials: E
authors.lastname: Suh
authors.affiliation: Office of Transformative Global Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Sireesha J
authors.initials: SJ
authors.lastname: Bobbili
authors.affiliation: Office of Transformative Global Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, Department of Public Health Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile and Department of Psychiatry, University of Toronto, Ontario, Canada Jaime.Sapag@camh.ca.
authors.forename: Jaime C
authors.initials: JC
authors.lastname: Sapag
mesh_terms: D003299:Cooperative Behavior; D003906:Developing Countries; D014943:Global Health; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007857:Leadership; D008605:Mental Health Services; D011050:Policy Making; D011320:Primary Health Care
keywords: Addiction; capacity building; global health; mental health; primary health care