Article Text

Participatory mental health interventions in low-income and middle-income countries: a realist review protocol
  1. Cheyann J Heap1,
  2. Hannah Maria Jennings2,3,4,
  3. Kaaren Mathias5,6,
  4. Himal Gaire7,
  5. Farirai Gumbonzvanda8,
  6. Nyaradzayi Gumbonzvanda9,
  7. Garima Gupta6,
  8. Sumeet Jain10,
  9. Bidya Maharjan11,
  10. Rakchhya Maharjan11,
  11. Sujen Man Maharjan11,
  12. Pashupati Mahat12,
  13. Pooja Pillai6,
  14. Martin Webber13,
  15. Jerome Wright2,
  16. Rochelle Burgess3
  1. 1Department of Social Work and Social Policy, University of York, York, UK
  2. 2University of York, York, UK
  3. 3UCL Institute for Global Health, London, UK
  4. 4Hull York Medical School, Hull and York, UK
  5. 5School of Health Sciences, University of Canterbury, Christchurch, New Zealand
  6. 6Burans, Herbertpur Christian Hospital, Uttarakhand, India
  7. 7Centre for Mental Health Counselling (CMC), Katmandu, Nepal
  8. 8Rozaria Memorial Trust, Harare, Zimbabwe
  9. 9Rozaria Memorial Trust, Harare, UK
  10. 10School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
  11. 11Chhahari Nepal for Mental Health (CNMH), Katmandu, Nepal
  12. 12Centre for Mental Health and Counselling, Katmandu, Nepal
  13. 13Department of Social Policy and Social Work, University of York, York, UK
  1. Correspondence to Dr Hannah Maria Jennings; hannah.jennings{at}


Introduction The 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 analysis A 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 dissemination Ethical 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.


This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors RB and HMJ initiated the review. All members of the network contributed toward the mind-map and conception of the protocol. Following discussions with the whole team CH designed and drafted the initial protocol, which was subsequently reviewed by BM, KM, PM, MW, RM, SM, JW, HMJ and RB. BM, PM, KM, GG, PP, FG, NG and CH have taken a lead in planning the FGDs. HMJ, RB, BM, PM, KM and PP have organised ethical approval in respective sites. RB and HJ finalised the protocol. All authors approved the final manuscript (CH, HMJ, HG, FG, NG, GG, SJ, BM, RM, SM, PM, KM, PP, WM, JW, RB).

  • Funding This work was supported by Global Challenges Research Fund Pump Priming Award funded through the UKRI-MRC (2019-2020/2020-21 H0027804).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.