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Background and aims

The COVID-19 pandemic had a substantial impact on global mental health care, impacting economies, social structures and health systems. The United Nations (UN) recommended three key actions for all nations:

  1. To apply a whole-of-society approach to promote, protect and care for mental health.
  2. To ensure widespread availability of emergency mental health and psychosocial support.
  3. To support recovery from COVID-19 by developing future mental health services.

In low income and middle income countries (LMICs), mental health services are chronically underfunded and ignored, with over 90 percent not receiving mental health treatment. These challenges, alongside the COVID-19 pandemic, questioned the feasibility of implementing the recommended actions due to the lack of resources in LMICs.


The National Institute of Mental Health (NIMH) developed a network of global research Hubs called ‘NIMH Scale-Up Hubs” to address these questions. The interdisciplinary hubs aimed to:

  • Increase the reach, accessibility, quality, costs and effectiveness of mental health services.
  • Enhance collaborative learning and development.
  • Build local capacity for implementation research.
  • Establish relationships with governmental, non-governmental and community-based stakeholders.

Outcomes and Benefits

Some hubs focused on integrating digital technology in mental health service delivery:

  • Pakistan: Online training programmes were integrated for teachers in education platforms, with interactive chat bots used to identify and manage emotional and behavioural problems in school children.
  • India: Digital technology was implemented to train community health workers to deliver psychological treatment for depression, allowing sessions to be delivered in primary care settings in deprived states.
  • Columbia: Digital technology was implemented for screening and treatment of depression and alcohol use. This involved using computerised clinical assessments, digital clinical decision support tools to aid treatment choices and a digital application to promote behaviour change amongst patients.
  • Mozambique: An electronic mental wellness tool was implemented; helping community health workers, primary care providers and mental health specialists to accurately identify mental disorders, provide standardised interventions and prevent suicide through connecting with electronic medical records.

The hubs adapted their global programmes in response to COVID-19 by introducing training modules in Pakistan for teachers managing pandemic-related anxiety in school children. Additionally, in India, Columbia and Mozambique, digital tools were developed to manage stress, anxiety and depression in frontline workers responding to patients with COVID-19.

Overall, these hubs were successful in addressing the immediate and long-term mental health challenges, and through the implementation of digital technology, mental health services can be improved beyond the COVID-19 pandemic. Additionally, the Scale-Up Hubs were ideally positioned to form a collaborative network focused on advancing the science of implementing and sustaining evidence-based mental health services in LMICs (Naslund et al., 2021).

To find out more information, watch the videos of each project summary on the National Institute of Mental Health page.


Naslund, J. A., Kalha, J., Restivo, J. L., Amarreh, I., Callands, T., Chen, H., ... & Pathare, S. (2021). Identifying challenges and recommendations for advancing global mental health implementation research: A key informant study of the National Institute of Mental Health Scale-Up Hubs. Asian journal of psychiatry, 57, 102557. Available at:

Additional information

You can find out more about the NIMH Scale-Up Hubs by accessing the Lancet Research Article.

The aim of the ZSA Case Studies is to introduce users to a range of examples of new and innovative practice, with the broad aim of working to support people with their mental health, bring awareness to and help prevent incidence of suicide. Please seek further information by contacting the ZSA and appropriate professional input prior to making a decision over its use.

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Content last updated: 25/11/2022

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