Towards integration of service user knowledge in mental healthcare in low and middle-income countries: insights from Transition Theory


  • Alida Joanna van der Ham
  • Laura S Shields
  • Jacqueline E. W. Broerse


mental health, health care, service users, developing countries, transition theory, knowledge integration, niche, regime, landscape


Service user involvement is promoted worldwide as a strategy to have a more needs-based and more responsive mental healthcare. However, there is limited knowledge about the role of service users in low and middle income countries. In this paper, we explore the potential of service user involvement in developing ‘good’ mental healthcare in LMICs. This is done using Transition Theory, by outlining barriers and opportunities in terms of the dominant structure, culture and practice of a mental healthcare system and how they relate to integration of service user knowledge. Current situations are described thereby providing insight into regime factors that hamper knowledge integration. Some important hampering factors include: the lack of mental health policy, legislation and resources, stigma and power differences between professionals and service users. In addition, the envisioned changes are elaborated upon, signifying identified facilitators and possible opportunities for change at the niche level and landscape level. Opportunities for integration of service user knowledge might be found in adopting rights-based, wellbeing-oriented approaches thereby connecting to broader societal trends. In addition, adopting strategies of deepening, broadening and scaling-up of current initiatives at the niche level might enhance shift towards integration of service user knowledge.