Purpose Calls for “mutuality” in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared. Methods We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH. Results Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators’ needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South. Conclusion Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept.

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When Open Dialogue diversifies internationally as an approach to mental healthcare, so too do the research methodologies used to describe, explain and evaluate this alternative to existing psychiatric services. This article considers the contribution of anthropology and its core method of ethnography among these approaches. It reviews the methodological opportunities in mental health research opened up by anthropology, and specifically the detailed knowledge about clinical processes and institutional contexts. Such knowledge is important in order to generalize innovations in practice by identifying contextual factors necessary to implementation that are unknowable in advance. The article explains the ethnographic mode of investigation, exploring this in more detail with an account of the method of one anthropological study under way in the UK focused on Peer-Supported Open Dialogue (POD) in the National Health Service (NHS). It sets out the objectives, design and scope of this research study, the varied roles of researchers, the sites of field research and the specific interaction between ethnography and Open Dialogue. This study is original in its design, context, conduct and the kind of data produced, and presents both opportunities and challenges. These are explained in order to raise issues of method that are of wider relevance to Open Dialogue research and anthropology.

Objectives To address the lack of individual-level socioeconomic information in electronic health care records, we linked the 2011 census of England and Wales to patient mental health records from a large secondary mental healthcare provider. This paper describes the linkage process and methods for mitigating bias due to non-matching. Setting South London and Maudsley NHS Foundation Trust (SLaM), a mental health care provider in southeast London. Design Clinical records from SLaM were supplied to the Office of National Statistics (ONS) for linkage to the Census through a deterministic matching algorithm. We examined clinical (ICD-10 diagnosis, history of hospitalisation, frequency of service contact) and sociodemographic (age, gender, ethnicity, deprivation) information recorded in CRIS, as predictors of linkage success with the 2011 Census. To assess and adjust for potential biases caused by non-matching, we evaluated inverse probability weighting for mortality associations. Participants Individuals of all ages in contact with SLaM up until December 2019 (N=459,374). Outcome measures: Likelihood of mental health records' linkage to census. Results 220,864 (50.4%) records from CRIS linked to the 2011 census. Young adults (Prevalence ratio (PR) 0.80, 95% CI 0.80-0.81), individuals living in more deprived areas (PR 0.78,0.78-0.79), and minority ethnic groups (e.g., Black African, PR 0.67, 0.66-0.68) were less likely to match to Census. After implementing inverse probability weighting, we observed little change in the strength of association between clinical/demographic characteristics and mortality (e.g., presence of any psychiatric disorder: unweighted PR 2.66, 95% CI 2.52, 2.80; weighted PR 2.70, 95% CI 2.56, 2.84) Conclusions Lower response rates to the 2011 census amongst people with psychiatric disorders may have contributed to lower match rates, a potential concern as the census informs service planning and allocation of resources. Due to its size and unique characteristics, the linked dataset will enable novel investigations into the relationship between socioeconomic factors and psychiatric disorders in the future.