Table 1.

Summary of barriers to involvement and strategies to facilitate involvement

Barriers hindering involvement in national health system processes	Strategies to facilitate involvement
Lack of awareness and information Lack of awareness regarding the ‘why’ and ‘how’ of involvement among service users, caregivers, and policy makers Lack of confidence to participate due to lack of information Ignorance among policy makers that leads to failure to prioritize mental health	Raising awareness Use of media: documentary/drama, street-plays, posters, pamphlets, radio, TV programs, billboards Incorporation of mental health issues in school education Interpersonal interactions among community members For policy makers- interaction with service users/caregivers, field visits to health centers, awareness workshops
Stigma and discrimination Service users and caregivers feel humiliated and don’t want to identify themselves or become involved due to stigma No space in government positions for service users Psychiatrists unwilling to work with service users on equal grounds	Reduction of stigma Through awareness-raising, education, employment opportunities, quota for government positions Getting rid of discriminatory words such as ‘service users’ and ‘service providers’
Poor economic conditions and competing priorities Focus on earning a living, so no time to spare for involvement Expectation of free treatments and medicine, involvement in income generating activities rather than system processes	Formation of service user and caregiver groups at grassroots level Bottom-up approach: service user/caregiver groups should be established in villages Supports involvement of service users/caregivers from rural areas
Centralization of national health system processes No access to system strengthening processes for those living in rural areas; health system processes mostly take place in major cities	Capacity building Training should be conducted by the government Training should address basic knowledge of mental illness, its types, and treatments, mental health systems and system strengthening, their needs and roles of service users/caregivers
Lack of strong leadership and unity among service user community Disjuncture among service users representing organizations A sense of competition among service user organizations Conflicting views regarding selection of representatives Lack of consensus on how/to what extent service users should be involved in policy development
	Selection of representatives Selection to represent the population from grassroots level Representation of all demographic, economic and geographical groups needed
	Methods of involvement Involvement should take place at different levels of policy making Monitoring: formation of monitoring committee with service users, caregivers, service providers, government employees as its members Research: involvement mainly in data collection