Global mental health commentary: using innovation to create a workforce to deliver and implement culturally adapted CBT in Pakistan.

Most low- and middle-income countries (LMICs) have poor or non-existent mental healthcare. Many of LMIC countries allocate less than 1% of their health budgets to addressing mental illness, making large-scale public health interventions not a practical option, at least for the foreseeable future. Psychiatric services are limited to large urban centres, and mental health literacy is low. There is increasing international recognition of the need to build capacity to strengthen mental health systems in LMICs.The aim of this paper is to offer a reflective commentary on our research undertaken over 15 years in Pakistan psychiatric services to create a workforce and culturally adapted cognitive behaviour therapy (CBT) model for LMICs that works for diverse communities served. The exemplar of our work discussed in this article can be used as lessons for developing mental health therapies for LMICs and other countries with diverse communities globally. Our discussion is based largely, if not, on all aspects describing the key barriers and facilitators to implementation of a workable culturally adapted CBT model for use in Pakistan or any similar LMICs. We report on the implementation of culturally adapted CBT in Pakistan over the past 15 years to improve the identified gaps in evidence. We also highlight the successful dissemination strategies our group employed for successful adaption and implementation.