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Item Open Access Is challenge really better than competition?: Testing the theory in my practice(2016) McHaffie , Andrew; North , ChrisThis practitioner-research compares the effects of competition and challenge on students’ enjoyment in PE. The data was collected during six lessons in the context of a gymnastics unit in a junior high school setting. Three lessons were based on challenge and the other three on competition. Data sources included my students, my associate teacher and my own reflections. The findings from all three data sources suggested that competition had an overall negative effect on student enjoyment. Two key themes emerged during analysis: student participation and student interactions. After transitioning to competition from challenge, 42% of the students reported a decline in their desire to participate and it was noted by all sources that there was an increase in negative student interactions. Details of context are provided so readers can consider the importance of this research for their own teaching practices. Pedagogical approaches to PE framed through challenge appear to open up the possibilities for students to engage with learning as envisioned in the New Zealand Curriculum.Item Open Access Environmental myopia: The case for bifocals(Cambridge University Press (CUP), 2012) North, Chris; Hutson GDomestic and international tourists have major impacts on Aotearoa/New Zealand, both positive and negative. In 2010, tourism was the biggest export earner and continues to grow. Environmental consequences of tourism are also growing. Ways of addressing the environmental impacts caused by a mobile society continue to be debated from a variety of practical and theoretical positions. Place-based approaches are a logical discussion focus in addressing these types of social and environmental problems but may be associated with environmental myopia. Tourism, mobility and the principles of environmental education programs such as Leave No Trace are all contested topics within the place-based discourse. This article discusses these tensions and proposes an expansion of place-based and cosmopolitan approaches, with the Leave No Trace Aotearoa/New Zealand campaign presented as an example. The article concludes with possible implications of a more bifocal approach for environmental educators. Copyright © Cambridge University Press 2011.Item Open Access Reliability and Relationship between Hip Muscle Strength and Change of Direction Performance among Basketball Players(Australian International Academic Centre, online-publication-date) Faulks T; Drury M; Walter, SibiBackground: Basketball change of direction (COD) tests are not specific to the defensive lateral shuffling movement, and no COD tests assesses the relationship between hip muscle strength and basketball specific lateral movements. Objective: We assessed the reliability of a COD test (2-2 shuffle test) performance and investigated its relationship to hip muscle strength. Methods: Using a prospective observational cohort design, data were collected from competitive male basketball players (n = 21; age 20.0 ± 3.5 years; height 194.7 ± 7.0 cm; weight 93.9 ± 14.7 kg). Participants performed two trials of the hip abductors/adductors isometric muscle strength assessment and the 2-2 shuffle test. Intraday reliability of the 2-2 shuffle test was computed using Bland-Altman plots, intraclass correlations (ICCs) with 95% confidence intervals (CI), and coefficient of variations (CVs). Pearson correlations with 95% CIs determined the relationship between shuffle test time and hip muscle’s isometric strength. Results: The 2-2 shuffle test time for left (ICC = 0.91, CV = 7.7%) and right (ICC = 0.86, CV = 8.4%) directions met acceptable reliability thresholds (ICC 0.8, CV 10%). The relationships observed between 2-2 shuffle test time and hip abductors/adductors were non-significant and unclear across parameters (p = 0.05, r = ≤ -0.26). Conclusion: Physical performance coaches may use the 2-2 shuffle test as the test time is a reliable metric. The hip abductors/adductors maximal isometric strength accounts for a trivial proportion of explained variance in the 2-2 shuffle test, suggesting other technical and physical abilities account for test performance.Item Open Access Exploring the early experiences of assisted dying in Aotearoa New Zealand: a qualitative study protocol(2024) Reid, Kate; Young, Jessica; Dehkhoda, Aida; Ahuriri-Driscoll, Annabel; Cheung, Gary; Egan, Richard; Karaka-Clarke, Te Hurinui; Moeke-Maxwell, Tess; Robinson, Jackie; Snelling, Jeanne; White, Ben; Winters, Janine Penfield; Diesfeld, KateIntroduction Increasing numbers of jurisdictions are legalising assisted dying (AD). Developing research protocols to study the experiences and outcomes of legislation is imperative. AD is a topic that, by nature of its complexity and inherent ethical issues, lends itself to qualitative research. Using the objectives of the statutory framework, this qualitative study aims to provide a robust review of the newly formed AD service in New Zealand and the extent to which it is safe, people-centred, dignity-enhancing, accessible and available equitably to all eligible people. Methods and analysis The research uses an appreciative inquiry design to focus on what is working well, what could be improved, what constitutes the ‘ideal’ and how to enable people to achieve that ideal. We are using online semi-structured interviews and face-to-face focus groups to explore the experiences of key stakeholders: eligible/ ineligible service users; eligible/ineligible service users with impairments; families of service users; AD providers; non-providers (providers who object to AD and others who are not directly involved in providing AD but are not opposed in principle); health service leaders; and Māori community members. An estimated 110 participants will be interviewed. We will conduct thematic and regulatory analyses of data. Ethics and dissemination The ethical aspects of this study have been approved by the Northern A Health and Disability Ethics Committee through the full review pathway (2023 EXP 18493). To disseminate the findings, we will draft resources to support interviewee groups, to be developed with feedback from stakeholder meetings. We will submit evidence-based recommendations to inform the government review of the End of Life Choice Act 2019. Findings will be disseminated in peer-reviewed publications, conferences, webinars, media, stakeholder feedback sessions and accessible research briefings.Item Open Access Soldier Suicides(2022) Maddocks, WendyItem Open Access A Systematic Review of Lower Limb Strength Tests Used in Elite Basketball(MDPI AG, online-publication-date) Faulks T; Sansone P; Walter, SibiBackground: Basketball players rely on their lower limb strength for speed and agility. Therefore, it is important for strength and conditioning coaches to seek methods to assess and develop lower limb strength. Objectives: This study aimed to identify tests and variables used to assess lower body strength among elite basketball players and to provide normative values for the commonly used strength tests. Methods: A review of PubMed, MEDLINE, Scopus, and SPORTDiscus was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The risk of bias was assessed using the Joanna Briggs Institute cross-sectional and cohort checklists. Results: Among the twelve reviewed studies, seven strength tests and five outcome variables were used. The most frequently used lower limb strength tests were the back squat (nine studies) and isometric mid-thigh pull (IMTP) (three studies), both reporting one repetition maximum (1RM) and peak force metrics. The most frequently used lower limb strength test was the back squat among males and IMTP among females. Conclusions: Among elite basketball players, the back squat 1RM is the most used lower limb strength test. However, across studies, a large variability was evidenced, which suggests that lower limb testing procedures are heterogeneous in this population.Item Open Access Task-shifting or problem-shifting? How lay counselling is redefining mental healthcare(Public Library of Science (PLoS), 2024) Chase L; Shrestha P; Datta G; Forsythe N; Jain S; Maharjan SM; Mathias, Kaaren; Miguel-Lorenzo X; Ranganathan S; Shrestha S; Sidgel K; Subba P; Gautam K; Gurung D; Ntow MC; Montague-Cardoso KItem Open Access Comparison of Multiple Hop Test Kinematics Between Force-Platforms and Video Footage – A Cross Sectional Study(Australian International Academic Centre, online-publication-date) Sharp , Anthony P.; Cronin , John B.; Neville , Jonathon; Diewald , Shelley N.; Stolberg , Michael; Draper , Nick; Walter, SibiBackground: Multiple hop performances have been assessed using force-platforms and motion-capture cameras. However, the accessibility of these technologies might be a hindering factor for many performance coaches. Currently, tablet devices are being used as alternatives to measure jumping and hopping performances. Objective: This study aimed to compare multiple hop kinematics using the Kinovea application with force-platforms, the gold standard. Methods: Using an observational cross-sectional study design, male athletes (n=44; age 20.1 ± 1.4 years) completed triple hops (3-Hop) and quintuple hops (5-Hop) on force-platforms while being filmed using an iPad. Ground contact time, flight time and total time were analysed using Kinovea and compared with the force platform data. Results: Statistical analysis showed a high level of agreement across all variables of interest but significant differences (flight time; -2.14 to -5.96 %, ground contact time; 4.89 to 5.83 %, total time; -0.37 to -0.58%) were observed across all variables of interest. A systematic bias for flight and ground contact times were seen for 3-Hop and 5-Hop. Conclusion: The use of iPad and Kinovea application can be used as a valid alternative to measure multiple hop kinematics when performance coaches do not have access to expensive force-platforms or motion-capture cameras.Item Open Access The inconvenient truth of illiteracy inequality intersectionality of socio-demographic disadvantage(2021) Gandhi , Sunita; Mathias, Kaaren; Seefeldt , Linda; Delaney , ThomasThis study analyses adult illiteracy in Lucknow, focusing on inequalities between different geographical regions, castes, age groups and genders. The reading ability of 1.06 million people in the 15–60 age group was tested, and the literacy rate found to be 65%—substantially lower than the census figures of 77% for Lucknow and 68% for Uttar Pradesh. Each socio-demographic dimension measured was a key determinant of literacy—disadvantaged groups had literacy rates substantially below the mean. Socio-demographic determinants also compound each other, highly disadvantaging some subgroups, an aspect that policymakers must take into consideration when developing policies to increase literacy equity.Item Open Access Prevalence and Risk Factors for Musculoskeletal Pain when Running During Pregnancy: A Survey of 3102 Women(Springer Science and Business Media LLC, 2024) Wyatt, Hannah; Sheerin , Kelly; Hume , Patria; Hébert-Losier , KimBackground: Musculoskeletal pain while running is a concern to women during pregnancy and can lead to running cessation. To support women who wish to run during pregnancy, it is essential to understand the sites, severities and personal risk factors associated with musculoskeletal pain. Objective: The aim was to investigate prevalence and risk factors for musculoskeletal pain when running during pregnancy. Methods: An online survey was completed by women who had a child in the past 5 years and ran prior to and during pregnancy. Pain frequency informed prevalence rates by body site, and logistic regression odds ratios (ORs) and 95% confidence intervals were calculated. Results: A total of 3102 women of 23 ethnicities from 25 countries completed the survey. Women were 22–52 years old when they gave birth and ran 2–129 km/week during the 0.5–35 years before the birth of their youngest child. Women ran significantly less distance and less often during pregnancy than before pregnancy. Most women (86%) experienced pain while running during pregnancy (59% pelvis/sacroiliac joint, 52% lower back, 51% abdomen, 44% breast, 40% hip). The highest prevalence of severe-to-worst pain was at the pelvis/sacroiliac joint (9%). Women at greatest risk of pain while running during pregnancy had a previous injury (OR = 3.44) or were older (OR = 1.04). Women with a previous child were less likely to experience breast pain (OR = 0.76) than those running during their first pregnancy. Conclusion: Healthcare practices to reduce pain should focus on regions of greatest musculoskeletal change during pregnancy, specifically the pelvis, lower back and abdomen. Efforts to support women to run for longer throughout pregnancy should focus on pain at the pelvis and breasts.Item Open Access Mana whenua engagement in Crown and Local Authority-initiated environmental planning processes: A critique based on the perspectives of Ngāi Tahu environmental kaitiaki(Wiley, 2021) Bennett C; Matunga H; Steyl S; Borell, Phil; De Jesus Dionisio, Maria Rita ; Hāpuku AIn New Zealand, the Crown and Local Authorities are required to engage with iwi in resource management matters, yet iwi engagement is a widely recognised weakness in many resource management professionals' skillsets. Coloniality permeates many interactions with iwi, and reflects a profession where practitioners' skillsets have not kept pace with developments in resource management legislation that better recognise the rights and interests of mana whenua. This article explores the real-life impacts of this skill paucity on Ngāi Tahu environmental kaitiaki, and, through a Braided River methodological approach comprised of Kaupapa Māori research and Narrative Inquiry, offers recommendations for best practice mana whenua engagement. The article concludes by discussing the coloniality of planning, and how this impacts practitioners' ability to implement these best practice recommendations.Item Open Access Gym and Fitness Injuries amongst those Aged 16–64 in New Zealand: Analysis of Ten Years of Accident Compensation Corporation Injury Claim Data(Springer Science and Business Media LLC, 2024) Cuthbertson-Moon M; Hume PA; Wyatt, Hannah; Carlson I; Hastings BBackground: To provide epidemiological data for minor and moderate-to-serious injury claims for gym and fitness related injuries amongst those aged 16–64 in New Zealand, to inform the development of an injury prevention program. Methods: Retrospective analytical review of gym and fitness related injury entitlement minor and moderate- to-serious Accident Compensation Corporation (ACC) claims from 1 July 2011 to 30 June 2020. Data were analysed by cause of injury, geographical region, sex, age, body site and injury type. Qualitative analysis of free text describing the activity causing the injury was conducted. Results: Over the ten-year period, 16–64 year olds made 345,254 injury claims, costing ACC NZ$241,298,275 in treatment charges. Soft tissue injuries were the most prevalent making up 96% (331,343) of all claims and 88% (NZ$213,049,197) of the total charges. Strenuous movement with lifting (n = 154,467, 47%), strenuous movement without lifting (n = 84,469, 25%), impact/contact with object (n = 39,610, 12%) and impact/contact with ground (n = 25,351, 8%) were the top four mechanisms resulting in injury, accounting for 92% of soft tissue injuries. Males and females aged 21 to 30 years old were most frequently injured. The four most injured body sites (lower back/spine, shoulder, knee, neck/back of head) accounted for 63% of injuries in females, and 65% in males. Conclusions: The most common cause of injury from gym and fitness activity claims in 16–64 year olds in New Zealand was lifting/carrying/strain resulting in lower back/spine and shoulder (including clavicle/blade) soft tissue injuries. Soft tissue injuries accounted for 96% of the total claims. Males and females aged 21 to 30 years old were most frequently injured age group.Item Open Access Critical reflections on the concept and impact of “scaling up” in Global Mental Health(SAGE Publications, 2023) Bayetti C; Bakhshi P; Davar B; Khemka GC; Kothari P; Kumar M; Kwon W; Mathias, Kaaren; Mills C; Montenegro CR; Trani JF; Jain SThe field of Global Mental Health (GMH) aims to address the global burden of mental illness by focusing on closing the “treatment gap” faced by many low- and middle-income countries (LMICs). To increase access to services, GMH prioritizes “scaling up” mental health services, primarily advocating for the export of Western centred and developed biomedical and psychosocial “evidence-based” approaches to the Global South. While this emphasis on scalability has resulted in the increased availability of mental health services in some LMICs, there have been few critical discussions of this strategy. This commentary critically appraises the scalability of GMH by questioning the validity and sustainability of its approach. We argue that the current approach emphasizes the development of mental health services and interventions in “silos,” focusing on the treatment of mental illnesses at the exclusion of a holistic and contextualized approach to people's needs. We also question the opportunities that the current approach to GMH offers for the growth of mental health programmes of local NGOs and investigate the potential pitfalls that scalability may have on NGOs’ impact and ability to innovate. This commentary argues that any “scaling up” of mental health services must place sustainability at the core of its mission by favouring the growth and development of local solutions and wider forms of support that prioritize social inclusion and long-lasting mental health recovery.Item Open Access Dignity and Right to health award: ICMDA leadership in Christian health and development initiative(Christian Journal for Global Health, 2019) Mathias, Kaaren; Burke , MichaelThe Dignity and Right to Health Award (DRH) is an activity of the International Christian Medical and Dental Association (ICMDA) Leadership in Christian Health and Development Initiative. The WHO Constitution (1946) envisages “... the highest attainable standard of health as a fundamental right of every human being.”Item Open Access Scaling a group intervention to promote caregiver mental health in Uttarakhand, India: A mixed-methods implementation study.(Cambridge University Press (CUP), 2023) Agarwal , Disha; Bailie , Christopher R.; Rana, Samson; Balan , Laxman; Grills , Nathan J.; Mathias, KaarenCaregivers are integral to health and social care systems in South Asian countries yet are themselves at higher risk of mental illness. Interventions to support caregiver mental health developed in high-income contexts may be contextually inappropriate in the Global South. In this mixed-methods study, we evaluated the implementation and scaling of a locally developed mental health group intervention for caregivers and others in Uttarakhand, India. We describe factors influencing implementation using the updated Consolidated Framework for Implementation Research, and selected implementation outcomes. Key influencing factors we found in common with other programs included: an intervention that was relevant and adaptable; family support and stigma operating in the outer setting; training and support for lay health worker providers, shared goals, and relationships with the community and the process of engaging with organisational leaders and service users within the inner setting. We identified further factors including the group delivery format, competing responsibilities for caregivers and opportunities associated with the partnership delivery model as influencing outcomes. Implementation successfully reached target communities however attrition of 20% of participants highlights the potential for improving outcomes by harnessing enablers and addressing barriers. Findings will inform others implementing group mental health and caregiver interventions in South Asia.Item Open Access Does the "Nae Umeed" group intervention improve mental health and social participation? A pre–post study in Uttarakhand, India(Cambridge University Press (CUP), 2023) Bailie , Christopher R.; Pillai , Pooja S; Goodwin Singh , Atul; Leishman , Jed; Grills, Nathan J.; Mathias, KaarenAbstract There are few evidence-based interventions to support caregiver mental health developed for low- and middle-income countries. Nae Umeed is a community-based group intervention developed with collaboratively with local community health workers in Uttarakhand, India primarily to promote mental wellbeing for caregivers and others. This pre–post study aimed to evaluate whether Nae Umeed improved mental health and social participation for people with mental distress, including caregivers. The intervention consisted of 14 structured group sessions facilitated by community health workers. Among 115 adult participants, 20% were caregivers and 80% were people with disability and other vulnerable community members; 62% had no formal education and 92% were female. Substantial and statistically significant improvements occurred in validated psychometric measures for mental health (12-Item General Health Questionnaire, Patient Health Questionnaire-9) and social participation (Participation Scale). Improvements occurred regardless of caregiver status. This intervention addressed mental health and social participation for marginalised groups that are typically without access to formal mental health care and findings suggest Nae Umeed improved mental health and social participation; however, a controlled community trial would be required to prove causation. Community-based group interventions are a promising approach to improving the mental health of vulnerable groups in South Asia.Item Open Access Mutuality as a method: advancing a social paradigm for global mental health through mutual learning(Springer Science and Business Media LLC, 2023) Bemme , Dörte; Roberts , Tessa; Ae-Ngibise , Kenneth A.; Gumbonzvanda , Nyaradzayi; Joag , Kaustubh; Kagee , Ashraf; Machisa , Mercilene; van der Westhuizen , Claire; van Rensburg , André; Willan , Samantha; Wuerth , Milena; Aoun , May; Jain , Sumeet; Lund , Crick; Mathias, Kaaren; Read , Ursula; Taylor Salisbury , Tatiana; Burgess, Rochelle A.Purpose: Calls for “mutuality” in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared. Methods: We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH. Results: Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators’ needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South. Conclusion: Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept.Item Open Access A qualitative study to explore various meanings of mental distress and help-seeking in the Yamuna Valley, North India(Medknow, 2021) Rawat , Meenal; Jadhav , Sushrut; Bayetti , Clement; Mathias, KaarenContext: In rural India, mental healthcare remains limited due to scant state services and incongruency between provider- and patient-framing distress. Help-seeking by people with mental health problems is related to how meanings of distress are understood differently by individuals, based on their interaction with various actors in the community and the available cultural explanation within their local ecologies. Methodology: This study examines the mutually constituted relationship between meanings of mental distress and help-seeking among people residing in the Upper Yamuna Valley, Uttarakhand, North India. This qualitative study builds on six in-depth interviews with people with severe mental health issues and one person with epilepsy, referred as people with psychosocial disability (PPSD) in the study. The data analysis was iterative and followed thematic approach. Results: The study found that personal belief based on one's experience, such as negative self-judgment and wider cultural explanations, such as supernatural beliefs, as well as gender roles, impacted the way people address their mental health problems, in turn shaping their help-seeking behavior. Participants lost hope for a cure after years of trying to find an effective solution. Moreover, lack of access to care and remoteness of the mountainous area made help-seeking and recovery feel impossible. Conclusions: This study underscores the need for researchers and policy professionals to explore the local context and culture to improve care and treatment quality. The study also explains that personal explanation of psychosocial problems and help seeking are not unidirectional. It is a complex phenomenon layered with the local contexts which should be addressed in clinical practice, as well as future research. Finally, clinicians' training should address the local cultural language of distress to identify the problem and suggest an effective solution.Item Open Access Opening up the ‘black-box’: what strategies do community mental health workers use to address the social dimensions of mental health?(Springer Science and Business Media LLC, 2024) Jain, Sumeet; Pillai , Pooja; Mathias, KaarenPurpose: Community-based workers promote mental health in communities. Recent literature has called for more attention to the ways they operate and the strategies used. For example, how do they translate biomedical concepts into frameworks that are acceptable and accessible to communities? How do micro-innovations lead to positive mental health outcomes, including social inclusion and recovery? The aim of this study was to examine the types of skills and strategies to address social dimensions of mental health used by community health workers (CHWs) working together with people with psychosocial disability (PPSD) in urban north India. Methods: We interviewed CHWs (n = 46) about their registered PPSD who were randomly selected from 1000 people registered with a local non-profit community mental health provider. Notes taken during interviews were cross-checked with audio recordings and coded and analyzed thematically. Results: CHWs displayed social, cultural, and psychological skills in forming trusting relationships and in-depth knowledge of the context of their client's lives and family dynamics. They used this information to analyze political, social, and economic factors influencing mental health for the client and their family members. The diverse range of analysis and intervention skills of community health workers built on contextual knowledge to implement micro-innovations in a be-spoke way, applying these to the local ecology of people with psychosocial disabilities (PPSD). These approaches contributed to addressing the social and structural determinants that shaped the mental health of PPSD. Conclusion: Community health workers (CHWs) in this study addressed social aspects of mental health, individually, and by engaging with wider structural factors. The micro-innovations of CHWs are dependent on non-linear elements, including local knowledge, time, and relationships. Global mental health requires further attentive qualitative research to consider how these, and other factors shape the work of CHWs in different locales to inform locally appropriate mental health care.Item Open Access Women's freedom of movement and participation in psychosocial support groups: Qualitative study in northern India(Springer Science and Business Media LLC, 2019) Gailits N; Mathias, Kaaren; Nouvet E; Pillai P; Schwartz LBackground: Depression, the world's leading cause of disability, disproportionately affects women. Women in India, one of the most gender unequal countries worldwide, face systemic gender disadvantage that significantly increases the risk of common mental disorders. This study's objective was to examine the factors influencing women's participation in psychosocial support groups, within an approach where community members work together to collectively strengthen their community's mental health. Methods: This community-based qualitative study was conducted from May to July 2016, across three peri-urban sites in Dehradun district, Uttarakhand, Northern India. Set within an NGO-run mental health project, data were collected through focus group discussions with individuals involved in psychosocial support groups including women with psychosocial disabilities as well as caregivers (N = 10, representing 59 women), and key informant interviews (N = 8) with community members and mental health professionals. Data were analyzed using a thematic analysis approach. Results: The principal barrier to participating in psychosocial support groups was restrictions on women's freedom of movement. Women in the community are not normally permitted to leave home, unless going to market or work, making it difficult for women to leave their home to participate in the groups. The restrictions emanated from the overall community's attitude toward gender relations, the women's own internalized gender expectations, and most significantly, the decision-making power of husbands and mothers-in-law. Other factors including employment and education shaped women's ability to participate in psychosocial support groups; however, the role of these additional factors must be understood in connection to a gender order limiting women's freedom of movement. Conclusions: Mental health access and gender inequality are inseparable in the context of Northern India, and women's mental health cannot be addressed without first addressing underlying gender relations. Community-based mental health programs are an effective tool and can be used to strengthen communities collectively; however, attention towards the gender constraints that restrict women's freedom of movement and their ability to access care is required. To our knowledge, this is the first study to clearly document and analyze the connection between access to community mental health services in South Asia and women's freedom of movement.