Much of the literature about mental illness in low and middle income countries (LMICs) focuses on prevalence rates, the treatment gap, and scaling up access to medical expertise and treatment. As a cause and consequence of this, global mental health programs have focused heavily on service delivery without due exploration of how programs fit into a broader picture of culture and community. There is a need for research which highlights approaches to broader inclusion, considering historical, cultural, social, and economic life contexts and recognises the community as a determinant of mental health-in prevention, recovery, resilience, and support of holistic wellness. The purpose of this practice review is to explore the experiences of three local organisations working with people with psychosocial disability living in LMICs: Afghanistan, India, and Nepal. All three organisations have a wealth of experience in implementing mental health programs, and the review brings together evidence of this experience from interviews, reports, and evaluations. Learnings from these organisations highlight both successful approaches to strengthening inclusion, and the challenges faced by people with psychosocial disability, their families and communities. The findings can largely be summarised in two categories, although both are very much intertwined: first, a broad advocacy, public health, and policy approach to inclusion; and second, more local, community-based initiatives. The evidence draws attention to the need to acknowledge the complexities surrounding mental health and inclusion, such as additional stigmatisation due to multidimensional poverty, gender inequality, security issues, natural disasters, and additional stressors associated with access. Organisational experiences also highlight the need to work with communities' strengths to increase capacity around inclusion and to apply community development approaches where space is created for communities to generate holistic solutions. Most significantly, approaches at all levels require efforts to ensure that people with psychosocial disability are given a voice and are included in shaping programs, policies, and appropriate responses.

The war in Kosovo in 1999 resulted in the displacement of up to 1.5 million persons from their homes. On the subsequent return of the refugees and internally displaced persons, one of the major challenges facing the local population and the international community, was the rehabilitation of Kosovo's public health infrastructure, which had sustained enormous damage as a result of the fighting. Of particular importance was the need to develop a system of epidemic prevention and preparedness. But no single agency had the resources or capacity to implement such a program. Therefore, a unique six-point model was developed as a collaboration between the Kosovo Institute of Public Health, the World Health Organization, and an international, nongovernmental organization. Important components of the program included a major Kosovo-wide baseline health survey, the development of a provincewide public health surveillance system, rehabilitation of microbiology laboratories, and the development of a local capacity for epidemic response. While all program objectives were met, important lessons were learned concerning the planning, design, and implementation of such a project. This program represents a model that potentially could be replicated in other post-conflict or development settings.

Purpose: This study aimed to investigate the experiences of people living with a psychosocial disability in rural India and Nepal, and to highlight key barriers and enablers for inclusion.Method: Participatory action research approaches and Photovoice methodology were employed to investigate the lived experience of 32 participants in rural India and Nepal. There were 12 participants and 4 caregivers of people with psychosocial disability from each of the two countries. Semi-structured interviews with study participants were transcribed and analysed thematically to answer the study question.Results: The findings revealed themes related to various supports, meaningful engagement in activity, and community awareness. Among these categories were both enabling and impeding factors to inclusion, the presence or absence of which was typically associated with improvements or worsening of symptoms respectively.Conclusions and Implications: This study underscores the need for integrated community-based approaches that are multisectoral, inclusive of family, and strengthen community responses. Photovoice was also shown to be a feasible research methodology for providing insights into the lived experience of people with psychosocial disability and for fostering their empowerment.

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