The 'Big Picture', India: Understanding mental health research-to-policy pathways in Assam

The use of evidence to inform policymaking offers the best chance for actions to address the needs of the population they address, and with efficiency of public expenditure. Mental health has been recognised as a global development priority; and in Assam stakeholders have identified the need for a standalone state mental health policy. Therefore, this PhD aimed to create an in-depth understanding of the extent, and ways, in which research evidence informs the mental health policy agenda in Assam. A review of reviews was conducted to understand current knowledge on key theories and frameworks for evidence-informed health policymaking and explore their applicability to mental health agenda-setting in LMICs. A resultant conceptual meta-framework specific for mental health agenda-setting in LMICs was developed, then applied to, and refined through, empirical application to the case study of Assam using: semi-structured interviews, observations, an online survey, and document analysis. A key finding was that informal evidence (based upon personal experience) needs to be considered in addition to formal research evidence, to reflect the available evidence, and accordingly the scope of this study was expanded. Furthermore, as often considered, it was found policymakers should not be the only key users of evidence; stakeholders agreed the agenda should be co-created to reflect community priorities and needs. Reflecting the broader range of evidence and actors, more diverse approaches to strengthening the use of evidence are likely to be useful, including community-targeted approaches. Whilst evidence is critical, agenda-setting is complex, and evidence cannot be considered in isolation. Therefore, approaches that indirectly strengthen the use of evidence, by creating a conducive environment, are needed in addition to direct approaches which focus on the evidence itself. Further research should explore the potential approaches proposed and evaluate their effectiveness.