From capacity building to systems activation: lessons from India for psychosocial disaster preparedness in low- and middle-income countries

Psychosocial disaster preparedness in low- and middle-income countries faces a persistent structural gap between training completion and institutional deployment readiness. Drawing on a structured, multicentre residential training programme conducted by the National Institute of Mental Health and Neurosciences, India, and a critical review of published literature, this article identifies systems-level barriers to psychosocial activation and proposes a context-adapted, stepped-care, psychological triage framework for frontline health workers. Strengthening district mental health programme integration within disaster command systems, formalising referral pathways and scaling community-level task-shifting are priority reforms in improving the coordination, scalability and continuity of disaster mental health response.