CC BY 4.0 Attribution 4.0 InternationalAger, AlastairHermosilla, SabrinaSchafer, AlisonKestel, Dévora2024-10-232024-10-232024-10-212024-02-07Ager, A., Hermosilla, S., Schafer, A. and Kestel, D. (2024) ‘A process study of early achievements and challenges in countries engaged with the WHO Special Initiative for Mental Health’, International Journal of Mental Health Systems, 18(1), p. 31. Available at: https://doi.org/10.1186/s13033-024-00652-8.https://eresearch.qmu.ac.uk/handle/20.500.12289/13876https://doi.org/10.1186/s13033-024-00652-8From Springer Nature via Jisc Publications RouterHistory: received 2024-02-07, registration 2024-10-13, accepted 2024-10-13, epub 2024-10-21, online 2024-10-21, collection 2024-12-01Acknowledgements: We thank Md Rezaur Rahman, Zeina Jamal, and Alla Lysa for their work in document review, interviews, and preliminary thematic analysis, Paul Kadetz for quality assurance, and Dave Madinger for statistical analysis. The following WHO staff input into the review process: Ben Adams (WHO HQ), Hadeel Alfa (WHO Jordan), Joana Ansong (WHO Ghana), Sadhana Bhagwat (WHO Bangladesh), Sudipto Chatter (WHO HQ), Dan Chisholm (WHO HQ), Sajeeva Ranaweera (WHO South East Asia Regional Office, SEARO), and Giovanni Sala (WHO HQ).Publication status: PublishedFunder: World Health Organization; doi: http://dx.doi.org/10.13039/100004423; Grant(s): RFP 08/2022/SIMH/MidtermLearnings, RFP 08/2022/SIMH/MidtermLearningsAlastair Ager - ORCID: 0000-0002-9474-3563 https://orcid.org/0000-0002-9474-3563Background: There is increasing awareness of the importance of the transformation of mental health systems. Launched in 2019, the WHO Special Initiative for Mental Health seeks to accelerate access to quality and affordable care for mental health conditions as an integral component of Universal Health Coverage. Nine countries are currently engaged with the initiative. Methods: This study reviewed processes of implementation—and progress achieved—across all settings by late 2022. It involved review of 158 documents provided by WHO relating to Special Initiative activities and 42 interviews with country-level stakeholders, WHO Regional and HQ personnel engaged with the initiative, and core donors. Documents were thematically coded using a template based upon the WHO framework of health system building blocks. Responses to structured interviews were coded based on an emergent thematic framework. Results: Documentation reported similar achievements across all domains; however challenges were reported most frequently in relation to service delivery, leadership and governance, and workforce. Issues of financing were notable in being twice as likely to be reported as a challenge than a success. Interviews indicated four major areas of perceived achievement: establishing a platform and profile to address mental health issues; convening a multi-stakeholder, participatory engagement process; new, appropriate services being developed; and key developments in law, policy, or governance around mental health. The planning process followed for the initiative, senior country-level buy-in and the quality of key personnel were the factors considered most influential in driving progress. Ambivalent political commitment and competing priorities were the most frequently cited challenges across all interviewees. Conclusions: The role of the Special Initiative in raising the profile of mental health on national agendas through a participatory and inclusive process has been widely valued, and there are indications of the beginnings of transformational shifts in mental health services. To secure these benefits, findings suggest three strategic priorities: increasing political prioritisation and funding for systems-level change; clearly articulating sustainable, transformed models of care; and promoting feasible and contextualised measures to support accountability and course correction. All are of potential relevance in informing global strategies for mental health systems transformation in other settings.Licence for this article: http://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. 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