{ "abstract": "Inclusive healthcare decision-making is a cornerstone of recovery-oriented mental health services, contributing to improved outcomes, enhanced autonomy, and reduced stigma. While substantial research on mental healthcare decision-making has been conducted in high-income countries, there is limited evidence from low- and middle-income countries (LMICs), where sociocultural norms, family structures, and health system constraints may shape decision-making differently. This review sought to synthesise evidence on service user and caregiver involvement in mental healthcare decision-making in LMICs and identify contextual factors influencing these processes. A scoping review was conducted following Arksey and O’Malley’s five-stage framework. English-language studies from 2008 to 2025 were identified through databases and grey literature searches. Eligible studies extracted examined the involvement of people with mental health conditions and/or caregivers in mental healthcare decision-making within LMICs. Two reviewers independently coded descriptions of involvement using an inductive content analysis approach. Three overarching themes emerged: (1) active user involvement, reflecting service users’ participation in and co-creation of decisions about their care; (2) family dominance, where family members significantly influenced or controlled decision-making processes; and (3) drivers of decision-making, including cultural norms, stigma, economic hardship, social relationships, and health system constraints. Overall, decision-making was predominantly shaped by family authority and contextual factors, with relatively limited evidence of shared or supported decision-making approaches. The search yielded 21,830 records, with an additional 46 studies identified through grey literature searches. Following screening, 36 studies were included. Studies were conducted across Africa (n = 12), Asia (n = 22), and the Middle East (n = 2). Mental healthcare decision-making in LMICs is embedded within complex family, cultural, and structural contexts that both enable and constrain service user participation. This review contributes to promoting a contextualised understanding of mental healthcare decision-making in LMICs.", "abstract_shown": true, "affiliations": [ "Division of Psychiatry, Institute for Neuroscience and Cardiovascular Research, University of Edinburgh, Edinburgh, United Kingdom.", "Pan African Network of Persons with Psychosocial Disabilities, Kigali, Rwanda.", "Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.", "Department of Social & Health Sciences, Millenium University, Blantyre, Malawi.", "Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.", "School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom.", "Kamuzu University of Health Sciences (KuHES), Blantyre, Malawi.", "Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom." ], "article_type": "Research Article", "arxiv": null, "author_total": 9, "authors": [ { "affs": [ 0, 1 ], "name": "Action Amos", "orcid": "0000-0001-5530-8561" }, { "affs": [ 2, 3 ], "name": "Sandra Jumbe" }, { "affs": [ 2 ], "name": "Thiyara Bandara", "orcid": "0009-0002-5890-7652" }, { "affs": [ 2 ], "name": "Sadiya Begum" }, { "affs": [ 0, 4 ], "name": "Charlotte Hanlon" }, { "affs": [ 5 ], "name": "Sumeet Jain" }, { "affs": [ 6 ], "name": "Martyn Pickersgill", "orcid": "0000-0001-9807-9148" }, { "affs": [ 7 ], "name": "Eric Umar", "orcid": "0000-0002-5269-031X" }, { "affs": [ 0 ], "name": "Robert C Stewart" } ], "bibtex": "https://research.draconitic.com/paper/f1j39xwg10bt4.bib", "cited_by": 0, "doi": "10.1371/journal.pmen.0000712", "fulltext_url": "https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000712", "id": "f1j39xwg10bt4", "issns": [ "2837-8156" ], "landing_url": "https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000712", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Biology and Life Sciences" ], [ "heading", "Caregivers" ], [ "heading", "Cognition" ], [ "heading", "Cognitive Psychology" ], [ "heading", "Cognitive Science" ], [ "heading", "Culture" ], [ "heading", "Decision Making" ], [ "heading", "Earth Sciences" ], [ "heading", "Economic Geography" ], [ "heading", "Economics" ], [ "heading", "Geography" ], [ "heading", "Health Care" ], [ "heading", "Health Care Facilities" ], [ "heading", "Low and Middle Income Countries" ], [ "heading", "Medicine and Health Sciences" ], [ "heading", "Mental Health and Psychiatry" ], [ "heading", "Neuroscience" ], [ "heading", "Psychology" ], [ "heading", "Public and Occupational Health" ], [ "heading", "Research Article" ], [ "heading", "Schizophrenia" ], [ "heading", "Social Sciences" ], [ "heading", "Socioeconomic Aspects of Health" ], [ "heading", "Sociology" ], [ "plos", "/Biology and life sciences/Neuroscience/Cognitive science/Cognition/Decision making" ], [ "plos", "/Biology and life sciences/Neuroscience/Cognitive science/Cognitive psychology/Decision making" ], [ "plos", "/Biology and life sciences/Psychology/Cognitive psychology/Decision making" ], [ "plos", "/Earth sciences/Geography/Economic geography/Low and middle income countries" ], [ "plos", "/Medicine and health sciences/Health care/Caregivers" ], [ "plos", "/Medicine and health sciences/Health care/Health care facilities" ], [ "plos", "/Medicine and health sciences/Health care/Socioeconomic aspects of health" ], [ "plos", "/Medicine and health sciences/Mental health and psychiatry" ], [ "plos", "/Medicine and health sciences/Mental health and psychiatry/Schizophrenia" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Socioeconomic aspects of health" ], [ "plos", "/Social sciences/Economics/Economic geography/Low and middle income countries" ], [ "plos", "/Social sciences/Psychology/Cognitive psychology/Decision making" ], [ "plos", "/Social sciences/Sociology/Culture" ] ], "openalex": null, "pdf_url": "https://journals.plos.org/mentalhealth/article/file?id=10.1371/journal.pmen.0000712&type=printable", "pmcid": "PMC13722329", "pmid": "42962062", "published": "2026-10-30", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/f1j39xwg10bt4.ris", "sources": [ { "first_seen": "2026-10-31T12:20:55Z", "native_id": "10.1371/journal.pmen.0000712", "source": "plos", "url": "https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000712" }, { "first_seen": "2026-11-02T03:21:21Z", "native_id": "MED:42962062", "source": "europepmc", "url": "https://europepmc.org/article/MED/42962062" }, { "first_seen": "2026-11-03T12:22:51Z", "native_id": "PMC13722329", "source": "pmc", "url": "https://doi.org/10.1371/journal.pmen.0000712" } ], "subjects": [ { "field": "biology", "origin": "plos:neuroscience", "subfield": "neuroscience" }, { "field": "earth", "origin": "heading:Earth Sciences", "subfield": "general" }, { "field": "medicine", "origin": "plos:public and occupational health", "subfield": "epidemiology-public-health" }, { "field": "medicine", "origin": "plos:mental health and psychiatry", "subfield": "psychiatry" } ], "title": "Involvement of users and caregivers in mental healthcare decision-making within low-and middle-income countries: A scoping review", "title_text": "Involvement of users and caregivers in mental healthcare decision-making within low-and middle-income countries: A scoping review", "type": "peer-reviewed", "updated_at": "2026-11-03T12:22:51Z", "url": "https://research.draconitic.com/paper/f1j39xwg10bt4", "venue": "PLOS Mental Health", "versions": [] }