Strengthening the quality and safety of community mental health care for children and young people: a critical review of innovations from low- and middle-income countries

Improving the quality and safety of community mental health care for children and young people (CYP) is a global public health priority. Mental health problems affect 10%-20% of CYP globally. While many high and low- and middle-income countries (LMICs) face significant structural barriers to accessing safe, person-centred mental health services, there have been innovative developments in service delivery emerging from low resource settings that are pertinent to address quality and safety of CYP mental health services globally. In this paper, we critically review emerging evidence from these contexts to highlight best practices and innovations. We focus on six key domains: task-sharing with non-specialists including peer and near-peer approaches; socio-economic interventions; alternative models of access; advances in routine outcome measurement; developing quality standards; and digital interventions. Through three case studies from Malaysia, Rwanda, and South Africa and other contexts within Sub Saharan Africa and high-income countries (HICs), we demonstrate how locally responsive, contextually appropriate solutions can strengthen mental health services in community settings. We argue for reciprocal co-production in global mental health, positioning LMICs as sources of innovation rather than passive recipients of external expertise. We conclude by discussing how these innovations offer transferable lessons for all contexts and identifying pathways to support their sustainability and scalability.