Implementation of Early Intervention in Psychosis Initiatives in Latin America and the Caribbean: A Case Study

Psychosis is a serious mental illness, with onset in adolescence and young adulthood. Few early intervention in psychosis (EIP) programs exist in the Global South, where most of the worlds youth live. Addressing this gap requires understanding implementation contexts, pathways and challenges. This study examines EIP initiatives in Latin America and the Caribbean (LAC) and explores implementers perspectives on scaling them. A single-case study design was employed. Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we conducted semi-structured interviews with EIP implementers across LAC and gathered policy documents. Data was coded and analyzed using thematic analysis. Twenty-five participants from 10 countries described 26 initiatives, including clinical and research programs, guidelines, and a technical standard. Themes were mapped onto the EPIS framework. In Exploration, participants highlighted key motivators, the influence of collaborations with foreign researchers, contextual adversity (e.g., poverty, stigma), and the role of Indigenous cosmologies and religious traditions in shaping care pathways. In Preparation, they emphasized difficulties in culturally adapting models from high-income countries (HICs), limited staff awareness, and resource shortages. In Implementation, participants described how initiatives operated in local contexts (e.g., research programs offering care to address unmet needs), how they were generally well received by patients and staff, and the shortage of psychosocial interventions. In sustainment, few initiatives persisted; participants pointed to dependence on international funding, limited policy support, capacity, and awareness. While EIP was valued, national dissemination of HIC-based programs was considered unfeasible. EIP development in LAC has occurred amid structural and resource limitations affecting many LMICs. Implementers proposals: task-shifting; simplified care packages; leveraging extant services; and enhancing early psychosis literacy-- represent feasible strategies to support EIP across LAC. Recommendations for future research, including the involvement of service users and their families and the adaptation of implementation frameworks to context, are shared.