An estimated 19–25% of perinatal women in low- and middle-income countries are affected by depression which, untreated, is associated with multiple health problems for mothers and children. Nonetheless, few perinatal women have access to depression care. The Thinking Healthy Programme (THP), promoted by the World Health Organization (WHO), is an evidence-based, non-specialist delivered depression intervention that addresses this care gap. However, the WHO THP manual explains intervention delivery but not the antecedents to implementation. Here, we describe a principled, planned approach leading to the implementation of THP in Lima, Peru by the non-profit organization Socios En Salud with community health workers (CHW) to inform its implementation in other settings.

The Replicating Effective Programs (REP) framework guided THP implementation, following four phases: (I) pre-conditions; (II) pre-implementation; (III) implementation; and (IV) maintenance and evolution. This paper centers on REP phases I and II, including (1) documented high perinatal depression rates in Peru; (2) designation of perinatal depression as a government priority; (3) THP Implementation Team orientation and training; (4) data collection plan development; (5) public health system coordination; (6) CHW selection and training; and (7) THP launch.

Between December 2016 and March 2017, a THP training program was developed and seven CHW were trained to deliver the intervention to 10 perinatal women, the first of whom was enrolled on 17 April 2017.

THP was rapidly implemented by a community-based organization with no prior experience in delivering non-specialist perinatal depression care. The steps followed may inform the implementation of THP in other settings.

There is a need for ecological approaches to guide global mental health programmes that can appropriately address the personal, family, social and cultural needs of displaced populations. A transactional ecological model of adaptation to displacement was developed and applied to the case of Syrian refugees living in Jordan.

Syrian and Jordanian psychosocial workers (n = 29) supporting the Syrian refugee community in Jordan were interviewed in three waves (2013–2016). A grounded-theory approach was used to develop a model of key local concepts of distress. Emergent themes were compared with the ecological model, including the five ADAPT pillars identified by Silove (2013).

The application of the ecological concept of niche construction demonstrated how the adaptive functions of a culturally significant concept of dignity (karama) are moderated by gender and displacement. This transactional concept brought to light the adaptive capacities of many Syrian women while highlighting the ways that stigma may restrict culturally sanctioned opportunities for others, in particular men. By examining responses to potentially traumatic events at the levels of individual, family/peers, society and culture, adaptive responses to environmental change can be included in the formulation of distress. The five ADAPT pillars showed congruence with the psychosocial needs reported in the community.

The transactional concepts in this model can help clinicians working with displaced people to consider and formulate a broader range of causal factors than is commonly included in individualistic therapy approaches. Researchers may use this model to develop testable hypotheses.