Implementing civic engagement within mental health services in South East Asia: a systematic review and realist synthesis of current evidence

James, Karen, Brooks, Helen ORCID logoORCID:, Susanti, Herni, Waddingham, Jessica, Irmansyah, Irman, Keliat, Budi-Anna, Utomo, Bagus, Rose, Diana, Colucci, Erminia ORCID logoORCID: and Lovell, Karina ORCID logoORCID: (2020) Implementing civic engagement within mental health services in South East Asia: a systematic review and realist synthesis of current evidence. International Journal of Mental Health Systems, 14 (1) , 17. pp. 1-13. ISSN 1752-4458 [Article] (doi:10.1186/s13033-020-00352-z)

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Introduction: Civic engagement (CE) has the potential to transform mental health services and could be particularly important for low and middle-income countries (LMICs), which are rapidly developing to respond to the burden of poor mental health. Research from high income countries has found many challenges associated with the meaningful implementation of CE in practice, but this has been underexplored in LIMCS and in South East Asia (SEA) in particular.

Methods: We completed a realist synthesis and systematic review of peer reviewed publications and grey literature to identify the context and actions which promote successful implementation of CE approaches in SEA. We used a theory-driven approach—realist synthesis—to analyse data and develop context-mechanism-outcome configurations that can be used to explain how civic engagement approaches operate in South East Asian contexts. We worked closely with patient and public representatives to guide the review from the outset.

Results: Fifty-seven published and unpublished articles were included, 24 were evaluations of CE, including two Randomized Controlled Trials. The majority of CE interventions featured uptake or adaptation of Western models of care. We identified important cultural differences in the enactment of civic engagement in SEA contexts and four mechanisms which, alongside their contextual barriers and facilitators, can be used to explain how civic engagement produces a range of outcomes for people experiencing mental health problems, their families and communities. Our review illustrates how CE interventions can be successfully implemented in SEA, however Western models should be adapted to fit with local cultures and values to promote successful implementation. Barriers to implementation included distrust of services/outside agencies, stigma, paternalistic cultures, limited resource and infrastructure.

Conclusion: Our findings provide guidance for the implementation of CE approaches within SEA contexts and identify areas for further research. Due to the collectivist nature of many SEA cultures, and the impact of shared traumas on community mental health, CE might best be implemented at community level, with a focus on relational decision making. Registration This review is registered on PROSPERO: CRD42018087841.

Item Type: Article
Keywords (uncontrolled): Review, CRD42018087841, CRD, Civic engagement, Patient and public involvement, Mental health, South East Asia, Realist synthesis, Global health
Research Areas: A. > School of Science and Technology > Psychology
Item ID: 30332
Notes on copyright: © The Author(s) 2020.
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. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit
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Depositing User: Jisc Publications Router
Date Deposited: 08 Jun 2020 08:49
Last Modified: 09 Feb 2022 10:37

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