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Item Open Access Case-based teaching of fatal incidents in outdoor education teacher preparation courses(Informa UK Limited, 2017) North , Chris; Brookes , AndrewThis article examines the use of case-based approaches to fatal incidents in outdoor education (OE) with a view to fatality prevention. Fatalities are rare in OE and therefore it is nearly impossible for teachers to learn how to avoid fatalities from their own past experiences. It is, however, possible to learn from the mistakes of others through studying accounts of fatalities. Andrew Brookes, working with specialist OE undergraduates nearing the end of their course, develops the argument for reframing fatality cases as narratives in order for students to not simply analyse the incident in hindsight, but to view the accounts from the perspectives of the people involved at the time. Chris North discusses how he examined the impact of case-based fatality learning on pre-service teachers with a range of outdoor experience levels. The responses of students to studying fatalities required him to reframe his approach and consider how to better differentiate learning. The article argues that case-based learning can make a unique and important contribution to safety, but requires reflexive consideration of both curricular and pedagogical aspects.Item Open Access Hearing and ear status of Pacific children aged 11 years living in New Zealand: the Pacific Islands families hearing study(Informa UK Limited, 2019) Purdy , Suzanne C.; Taylor , Steve; Schluter, Philip; Tautolo , El-Shadan; Iusitini , Leon; Ahmad , Zahoor; Sundborn , Gerhard; Paterson , JanisObjective: This study aimed to determine the prevalence of hearing loss and ear problems in Pacific children, and investigate current and past demographic, health and social factors potentially associated with hearing and ear problems. Design: A cross-sectional observational study design nested within a birth cohort was employed. Study sample: Nine-hundred-twenty Pacific children aged 11 years were audiologically assessed. Using average hearing thresholds at 500, 1k and 2k Hz, 162 (18%) right and 197 (21%) left ears had ≥20 dB hearing loss. Hearing loss was mild (20–39 dB) in most cases; 2% of ears had moderate to moderate-severe (40–69 dB) hearing loss. However, only 101 (11%) children had normal peripheral hearing defined by passing hearing threshold, tympanogram and distortion product otoacoustic emission assessments. Those with confirmed middle ear disease at age 2 years had significantly increased odds of a non-Type A tympanogram (adjusted odds ratio: 2.00; 95% confidence interval: 1.56, 2.50) when re-assessed at age 11 years. Conclusions: Hearing loss, abnormal tympanograms, and auditory processing difficulties were present in many Pacific children. Interventions are also urgently needed to mitigate the effect of the longstanding ear disease likely to be present for many Pacific children.Item Open Access Holding a sustainability bearing through cutty-grass and clearings: Implementing sustainability during disruptive organisational changes(2013) North, Chris; Jansen CThis article explores our experiences as faculty implementing a five year sustainability strategic plan within the Outdoor and Environmental Education (OEE) curriculum centre during a time of organisational restructuring. This paper builds on the work of Jansen and Boardman (2011) who describe the process of developing the strategic plan and some initiatives arising from it. Now at the end of the five year timeframe and with the benefit of hindsight, we describe some of the problematic aspects of our sustainability initiative. The role of a strategic plan appears crucial in providing a general bearing, however remaining ‘true’ to a small centre and its vision also limited possibilities for interdisciplinary sustainability. We discuss how disruptive organisational changes provided unexpected opportunities for our sustainability initiative. The ongoing journey through ‘cutty-grass thickets’ and ‘clearings’ for sustainability is described with a view to providing inspired self generalisation for others on a similar journey.Item Open Access Rain and Romanticism: the environment in outdoor education(Informa UK Limited, 2015) North, ChrisOutdoor education provides an opportunity to engage with natural environments in ways that are distinct from other physical education teacher education (PETE) courses. This research examines how pre-service teachers (PSTs) within a PETE degree experienced ‘environment’ on an outdoor education camp. Using selfstudy methodology and drawing on responses of students and my reflections, I sought to interrogate my Romantic assumptions. A particularly rainy camp provided rich opportunities and PST responses to the weather were diverse, because the rain prompted environmental responsiveness in ways that would not have occurred in fine weather. PSTs generally valued the affordances of the outdoor setting which they saw as distinct from daily schooling. However, contrary experiences also emerged, problematising my Romantic framing of the environment and indicating that my approach was marginalising some students. Implications for teachers and teacher educators are discussed.Item Open Access Swinging between infatuation and disillusionment: learning about teaching teachers through self-study(Informa UK Limited, 2017) North, Chris© 2016 Association for Physical Education. Background: School teachers who become teacher educators (TEs) are rarely prepared for the different pedagogies that teacher education requires. One pedagogical difference is the need for TEs to make their thinking and decisions explicit to pre-service teachers (PSTs) so PSTs can see teaching as an adaptive process rather than a set of routines to be memorised. Purpose: This research set out to analyse my learning about teaching teachers through making my decisions and thinking explicit to my PSTs. Participants and data collection: Using a self-study of teacher education practice (S-STEP) methodology, I collected data during an outdoor education course in a physical education (PE) degree. Participants included a convenience sample of six participating PSTs (of a cohort of 24) who participated in four interviews and two group interviews. Three critical friends observed five lessons and participated in interviews. In addition, self-generated data consisted of 104 written reflective journal entries (both private and open). Lessons were video-recorded to assist with reflection. Data analysis: Utilizing Schön’s concepts of reflection for, in and on action, I sought out contrary perspectives in order to frame and reframe my understanding of TE practice. I then presented these new understandings to other participants for further development. Findings: My learning about teaching teachers can be represented as swinging between opposite extremes of infatuation and disillusionment. After observing my teaching, a critical friend identified that my physical position (or how I placed myself in the group) affected PST engagement in discussions. As I explored this aspect of my teaching further, I became very focused on the influence of my physical position to the point of infatuation. My infatuation stage culminated in a reflection-in-action moment when I changed my position in the act of teaching, which appeared to significantly increase PST engagement. But the PSTs challenged my interpretation and stated that inequalities of power cannot be resolved by rearranging where a teacher stands. In this second stage, I experienced a strong sense of disillusionment, even cynicism. As a TE, I felt any actions I took were pointless against the power structures of society. Later, with insights from participants, I developed a more nuanced understanding of power and position; while not a panacea, how I arranged myself and the class physically did have some influence on the flow of discussions. Conclusions: S-STEP requires that researching practitioners challenge their assumptions. In making my own learning about my teaching explicit to my PSTs and critical friends, I was able to frame and reframe my understandings about teaching teachers. Through this research, I discovered that I learnt about my teaching by swinging between extremes. I argue that thinking about teaching informed by extreme positions, provides a fuller purview of the complexity of teaching teachers. S-STEP in conjunction with explicit teaching practices offers TEs a tangible means to understand our practices more deeply and furthermore, to advance our understanding of teacher education more broadly.Item Open Access The Impact of Drop Test Conditions on Brain Strain Location and Severity: A Novel Approach Using a Deep Learning Model(Springer Science and Business Media LLC, 2024) Stilwell, George; Stitt D; Alexander, Keith; Draper, Nick; Kabaliuk, NataliaIn contact sports such as rugby, players are at risk of sustaining traumatic brain injuries (TBI) due to high-intensity head impacts that generate high linear and rotational accelerations of the head. Previous studies have established a clear link between high-intensity head impacts and brain strains that result in concussions. This study presents a novel approach to investigating the effect of a range of laboratory controlled drop test parameters on regional peak and mean maximum principal strain (MPS) predictions within the brain using a trained convolutional neural network (CNN). The CNN is publicly available at https://github.com/Jilab-biomechanics/CNN-brain-strains. The results of this study corroborate previous findings that impacts to the side of the head result in significantly higher regional MPS than forehead impacts. Forehead impacts tend to result in the lowest region-averaged MPS values for impacts where the surface angle was at 0° and 45°, while side impacts tend to result in higher regional peak and mean MPS. The absence of a neck in drop tests resulted in lower regional peak and mean MPS values. The results indicated that the relationship between drop test parameters and resulting regional peak and mean MPS predictions is complex. The study’s findings offer valuable insights into how deep learning models can be used to provide more detailed insights into how drop test conditions impact regional MPS. The novel approach used in this paper to predict brain strains can be applied in the development of better methods to reduce the brain strain resulting from head accelerations such as protective sports headgear.Item Open Access Long-Term cost-effectiveness analysis of rugby fans in training-New Zealand: A body weight reduction programme for males(BMJ, 2024) Lee , Peter; Hargreaves , Elaine; Jiang , Yannan; Calder , Amanda; Marsh , Samantha; Gray , Cindy; Hunt , Kate; Eyles , Helen; Draper, Nick; Heke , Ihirangi; Kara , Stephen; Maddison , Ralph; Gao , LanObjectives We sought to extrapolate the long-Term costs and clinical impacts attributed to the rugby fans in training-New Zealand (RUFIT-NZ) trial in Aotearoa, New Zealand. Design A modelled cost-effectiveness analysis using efficacy data from RUFIT-NZ was conducted from the Aotearoa New Zealand healthcare perspective. Setting A Markov cohort model was constructed with a lifetime time horizon. The model simulated events of myocardial infarction (MI), stroke and type 2 diabetes mellitus (T2DM) occurring among a hypothetical cohort of 10 000 individuals receiving either the RUFIT-NZ intervention or no intervention. Efficacy data were based on the RUFIT-NZ trial, and the latest Global Burden of Disease study was used to extrapolate the impact of body weight reduction on clinical outcomes of T2DM, MI or stroke. Cost and utility data were drawn from the RUFIT-NZ trial and published sources. Primary outcome measures The incremental cost-effectiveness ratio (ICER). Results Over a lifetime time horizon, participants in the RUFIT-NZ intervention gained 0.02 (discounted) quality-Adjusted life years (QALYs) at an additional cost of NZ$863, relative to no intervention. The estimated ICER was NZ$49 515 per QALY gained (discounted), which is above the arbitrary willingness-To-pay threshold of NZ$45 000 per QALY. Sensitivity analyses supported the robustness of these findings. Conclusions RUFIT-NZ was associated with a reduction in cardiovascular and endocrine events for overweight and obese males. However, based on conservative assumptions, RUFIT-NZ was unlikely to be cost-effective from a healthcare system perspective. Trial registration number ACTRN12619000069156.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.