SEMH in Low and Middle Income Contexts
Access to effective mental health treatments and professionals represents a pervasive and persistent problem in low income countries. Top-down, homogeneous health interventions often fail in implementation and sustainability in such contexts – failing to connect with complex ‘collisions' of adversity.
However, in the very settings where harsh political, social, and economic conditions would seem to represent a total impasse, one can find compelling local examples of social innovation. There can be found individuals, social entrepreneurs, who are relentless in their effort to drive forward innovative solutions to major social problems. They operate effectively in contexts characterized by adversity and severe resource limitations, are highly embedded in the communities they work within, and they catalyze large amounts of social capital around solutions that are sustainable. The organization Ashoka has for decades recognized the tremendous potential in locating and supporting these highly leveraged solutions. In the Toronto context, we used this same approach to examine groups addressing mental health equity for marginalized populations. There we found organizations embedded within and having major impacts on the mental health of underserved communities – organizations that radically outperform what would be expected given their very limited economic resources (www.camh.net/semh).
With the support of GCC we used this framework to address the question: (1) Can a core, common set of implementation and program delivery characteristics be identified in the work of social entrepreneurs making inroads in mental health equity in low income countries?
To address these questions we used an intensive multiple case study design to examine the implementation strategies, interventions, and resource generation/utilization of Ashoka Fellows who are making inroads in mental health in low and low-middle income countries. We complemented these case studies with targeted conversations with (i) the broader group of Ashoka Fellows addressing mental health inequities internationally, (ii) a network of experts in business entrepreneurship, and (iii) a network of experts in health technology innovation.
This project was very helpful in our effort to flesh out the key attributes and activities of leading social entrepreneurs working in this space. Key outputs from the project included a scoping review, an in depth qualitative analysis and theoretical model that captures this type of work in low-middle income countries, and a practice guide for people working in the field developed from that analysis.