Review: Learning Inside the System: What Community-Based MHPSS Practice in Pakistan Teaches Us About Global Mental Health {under peer review}

 

Reviewer: Ruslan Kurmashev, MD

Completed: 11-05-2026 22:39

 

Recommendation: Revisions Required

 

 

	Yes	No	N/A
Is the research question clearly defined?	+
Are the methods appropriate and sufficiently detailed?		+
Is the data analysis robust and replicable?			+
Are the conclusions supported by the results?		+
Is the manuscript well organised and clearly written?	+
Are tables, figures, and supplementary material informative and necessary?			+
Is the abstract an accurate summary of the study?		+
Does the manuscript contribute meaningfully to the field?	+
Is it relevant to the field of mental health or related disciplines that are connected to the scope of the Journal?	+
Are ethical approvals and participant consents adequately described?	+
Have competing interests, funding, and data availability been transparently declared?	+

 

Comments for the authors:

 

The manuscript addresses an important and timely topic: how the experience of community-based MHPSS practice in Pakistan can reframe the training of specialists in global mental health. The central idea of the article - system-embedded pedagogy, that is, learning within actually functioning systems of care, is relevant, convincing and fits well within the scope of the journal. A particular strength of the manuscript is its attempt to show that knowledge emerging from LMIC practice should not be viewed merely as a "local adaptation" of global models, but can constitute an independent contribution to the pedagogical foundation of global mental health. The structure of the article is generally clear: the author moves consistently from the problem of GMH training to four practical cases, then to synthesis and recommendations for academic institutions .

Nevertheless, in its current form, the manuscript requires revision before it can be considered fully ready for approval. The main problem is that the article is positioned as a reflective practitioner case study or conceptual reflection, but at the same time uses language that sometimes implies a stronger level of empirical evidence than is actually presented. For example, statements that the approaches were “tested for efficacy", that everyday practice was used as "evidence", or that certain models were "more effective”, require either empirical support or substantial softening. If systematic data on effectiveness, trainee outcomes, competency trajectories or programme evaluation are absent, these claims should be reformulated as practice-informed observations or illustrative conceptual insights.

I recommend adding a separate short section “Reflective case-study approach” or “Methodological note”. In this section, it is important to explain: why these four cases were selected; over what period they were implemented, what role the author played in each of them, what sources were used for reflection, personal experience, programme documentation, supervision notes, training materials, institutional reports and what limitations arise from the author’s dual role as practitioner, programme contributor and analyst. Such a section does not need to turn the article into a formal qualitative study, but it would significantly increase the transparency and credibility of the argument.

It would also be advisable to standardise the description of the four cases. At present, they are written in an interesting way, but mainly narratively. It would be useful to add a table in which, for each case, the following are specified: setting, target group, workforce involved, pedagogical mechanism, source of reflection/evidence, and key limitation. This would make the connection between the cases and the proposed model of system-embedded pedagogy more verifiable.

The abstract also requires particular attention. It conveys the main idea of the article well, but in places it overstates the level of evidence. I recommend replacing formulations such as “tested”, “demonstrate” and “evidence base” with more cautious expressions, for example “illustrate”, “suggest”, “practice-informed”, “conceptual contribution”, unless empirical evaluation data can be provided.

Finally, the style of the manuscript is generally strong, but in some places too rhetorical or conversational for an academic article. Phrases such as “Honestly, that training did not produce…”, “The field has enough aspiration”, or “The field should be paying attention” would be better replaced with more neutral academic formulations. This would not weaken the argument, but would make it more convincing for an international audience.

Overall, I consider the manuscript valuable, relevant and potentially significant for global mental health education. However, before approval, the author should clarify the type of article, strengthen the methodological transparency of the reflective case-study approach, soften claims about effectiveness and evidentiary status, and present the four practical cases in a more structured way.