Quick summary: A comprehensive review of mental health services in 137 countries reveals that expanding early psychosis care beyond basic medication to include psychological support significantly improves patient well-being and clinical outcomes. Although 90% of people with psychosis live in lower-resource settings, formal early intervention programmes exist in only 11.7% of these nations, highlighting a critical gap in global healthcare equity. Governments and policymakers must now transition towards sustainable, culturally adapted care models that prioritise task-sharing and community-based support to address these structural imbalances effectively.
Most people living with psychosis are in low- and middle-income countries, yet access to the kind of joined-up, early care that has transformed outcomes in wealthier nations remains out of reach for millions. A comprehensive new systematic review has found that even modest expansions of early psychosis treatment in these settings can significantly improve patients’ lives, offering fresh impetus for governments to invest in mental health services.
The review, published in eClinicalMedicine, analysed 125 studies from 20 countries including India, Brazil, China, Mexico, and Nigeria. Researchers from McGill University and the Schizophrenia Research Foundation in Chennai screened more than 6,000 records to produce what is described as the most thorough examination to date of first-episode psychosis and clinical high-risk interventions in lower-resource settings.
Srividya Iyer, PhD, a professor at McGill University, noted that the motivation for the study came from a striking global imbalance. She explained: “Over 90% of people with psychosis live in low- and middle-income countries, yet most of the evidence guiding early intervention for psychosis comes from high-income countries. We know that early intervention in psychosis can significantly improve outcomes, but what early intervention approaches are being implemented or are effective in lower-resource contexts is unclear.”
Early intervention in psychosis typically combines medication with psychological and psychosocial support. The review found that when any psychological or psychosocial component was added to standard medication in these countries, outcomes improved compared to medication alone. Rubén Valle, PhD, a researcher from McGill University, highlighted the significance of these findings: “One of the most important findings from our review is that early intervention approaches for first-episode psychosis can improve outcomes in low- and middle-income countries. In other words, the evidence pointed clearly to the benefits of offering psychological or psychosocial components in addition to medication, rather than only prescribing medication as is often the case.”
Despite these encouraging findings, the review revealed significant gaps. Psychological and psychosocial components were inconsistently offered, and cognitive behavioural therapy for psychosis was notably absent from many services. Professor Iyer emphasized the structural challenges involved, stating: “These settings face very real structural challenges: limited specialist workforce, constrained funding, and fragmented service delivery. This raises an important question: can it be assumed that early intervention for psychosis models developed in high-income countries can simply be transferred, or do we need a more context-sensitive understanding of what is being delivered on the ground?”
Formal early psychosis programmes were identified in just 11.7% of the 137 countries examined. The authors argue that strict replication of Western models is unlikely to be appropriate. Regarding future directions, Professor Iyer added: “The goal is not to replicate high-income country models, but to co-develop sustainable, context-sensitive systems of care that can meaningfully improve outcomes for young people experiencing psychosis globally.”
The researchers conclude that governments in lower-income countries now have sufficient grounds to commit resources to expanding care, provided that cultural adaptation and large-scale implementation are prioritised.
