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.
Early intervention in psychosis typically combines medication with psychological and psychosocial support, including patient education, family involvement, cognitive behavioural therapy, and case management. The review found that when any psychological or psychosocial component was added to standard medication in these countries, outcomes improved compared to medication alone, spanning symptom reduction, functioning, quality of life, and treatment retention.
Despite these encouraging findings, the review revealed significant gaps. Psychological and psychosocial components, widely considered essential in high-income country guidelines, were inconsistently offered across programmes. Cognitive behavioural therapy for psychosis was notably absent from many services, and culturally adapted approaches were reported by only a handful of sites. CBT, where it did appear, was often not clearly tailored to psychosis specifically.
Formal early psychosis programmes were identified in just 11.7% of the 137 low- and middle-income countries examined for first-episode psychosis, and only 5.8% for clinical high-risk services. Most programmes were confined to single urban research centres rather than being embedded in broader health systems. Russia was the only country to report national-level implementation.
The evidence for clinical high-risk interventions remained especially thin. Only six relevant records were identified, none evaluating integrated treatment, and just three examining conversion to psychosis as an outcome. Researchers noted that limited funding, cultural barriers, and difficulties with community engagement make such studies particularly challenging to conduct in lower-resource settings.
The authors argue that strict replication of Western models is unlikely to be feasible or appropriate in these settings. Instead, they point to approaches such as task-sharing with non-specialist health workers, mobile health technologies, and community-based care as more realistic pathways to scaling up early psychosis support in countries with overstretched mental health workforce.
Economic analyses from Brazil and China included in the review suggested that early intervention programmes can also be cost-effective, adding weight to the case for sustained public investment. The researchers conclude that governments in lower-income countries now have sufficient grounds to commit resources to expanding multicomponent early psychosis care, provided that cultural adaptation and large-scale implementation are prioritised alongside further research.