title: A Multiple Case Study of Mental Health Interventions in Middle Income Countries: Considering the Science of Delivery.
abstract: In the debate in global mental health about the most effective models for developing and scaling interventions, there have been calls for the development of a more robust literature regarding the "non-specific", science of delivery aspects of interventions that are locally, contextually, and culturally relevant. This study describes a rigorous, exploratory, qualitative examination of the key, non-specific intervention strategies of a diverse group of five internationally-recognized organizations addressing mental illness in middle income countries (MICs). A triangulated approach to inquiry was used with semi-structured interviews conducted with service recipients, service providers and leaders, and key community partners (N = 159). The interview focus was upon processes of implementation and operation. A grounded theory-informed analysis revealed cross cutting themes of: a holistic conceptualization of mental health problems, an intensive application of principles of leverage and creating the social, cultural, and policy "space" within which interventions could be applied and resourced. These findings aligned with key aspects of systems dynamic theory suggesting that it might be a helpful framework in future studies of mental health service implementation in MICs.
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.|Toronto Centre for Addiction and Mental Health Toronto, Ontario, Canada.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Kidd
authors.affiliation: Toronto Centre for Addiction and Mental Health Toronto, Ontario, Canada.
authors.forename: Athena
authors.initials: A
authors.lastname: Madan
authors.affiliation: Toronto Centre for Addiction and Mental Health Toronto, Ontario, Canada.
authors.forename: Susmitha
authors.initials: S
authors.lastname: Rallabandi
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Donald C
authors.initials: DC
authors.lastname: Cole
authors.affiliation: Ashoka Canada,Toronto, Ontario, Canada.
authors.forename: Elisha
authors.initials: E
authors.lastname: Muskat
authors.affiliation: BasicNeeds,Bangalore, India.
authors.forename: Shoba
authors.initials: S
authors.lastname: Raja
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.|Toronto Centre for Addiction and Mental Health Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Wiljer
authors.affiliation: Ashoka, Washington D. C., United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Aylward
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.|Toronto Centre for Addiction and Mental Health Toronto, Ontario, Canada.
authors.forename: Kwame
authors.initials: K
authors.lastname: McKenzie
mesh_terms: D001459:Bangladesh; D003105:Colombia; D003695:Delivery of Health Care; D004534:Egypt; D016520:Entrepreneurship; D005869:Ghana; D006302:Health Services Research; D007194:India; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration*; D017146:Models, Organizational; D016730:Program Development; D012942:Social Sciences / Q000458:organization & administration; D013598:Systems Theory; D014744:Vietnam