Strengthening mental health systems in low- and middle-income countries: recommendations from the Emerald programme

Maya Semrau*, Atalay Alem, Jose L. Ayuso-Mateos, Dan Chisholm, Oye Gureje, Charlotte Hanlon, Mark Jordans, Fred Kigozi, Crick Lund, Inge Petersen, Rahul Shidhaye, Graham Thornicroft

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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There is a large treatment gap for mental, neurological or substance use (MNS) disorders. The 'Emerging mental health systems in low- and middle-income countries (LMICs)' (Emerald) research programme attempted to identify strategies to work towards reducing this gap through the strengthening of mental health systems.


To provide a set of proposed recommendations for mental health system strengthening in LMICs.


The Emerald programme was implemented in six LMICs in Africa and Asia (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) over a 5-year period (2012-2017), and aimed to improve mental health outcomes in the six countries by building capacity and generating evidence to enhance health system strengthening.


Me proposed recommendations align closely with the World Health Organization's key health system strengthening 'building blocks' of governance, financing, human resource development, service provision and information systems; knowledge transfer is included as an additional cross-cutting component. Specific recommendations are made in the paper for each of these building blocks based on the body of data that were collected and analysed during Emerald.


These recommendations are relevant not only to the six countries in which their evidential basis was generated, but to other LMICs as well; they may also be generalisable to other non-communicable diseases beyond MNS disorders.

Original languageEnglish
Article number73
Pages (from-to)1-5
Number of pages5
JournalBjpsych open
Issue number5
Publication statusPublished - 6 Aug 2019


  • Global mental health
  • health systems
  • health system strengthening
  • healthcare delivery

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