Current state of mental health and substance use in Toledo, Belize: A mixed methods study

Mental health and substance use are increasingly pressing issues in communities across low-and-middle income countries, including Belize, particularly Toledo, the country's most rural and resource-limited district. Using community-based participatory research methods, this preliminary mixed methods study (quantitative n = 163; qualitative n = 10) aims to (1) investigate mental health symptoms and substance use patterns in a non-randomized sample of individuals from southern Belize and (2) explore community perspectives on mental health among community stakeholders. Findings show high levels of depression, anxiety, and suicidal ideation among survey participants, which were supported by qualitative interviews. While low levels of substance use were reported by survey participants, qualitative findings diverged and showed alcohol use to be of significant concern among participants. Our study highlights the critical need for increased research, advocacy, and policy implementation regarding mental health and substance use in Toledo and across Belize. Given the scarcity of mental health resources in Toledo, findings underscore the urgent need for policy interventions that expand access to psychiatric services, integrate community-based mental health approaches, and address socioeconomic drivers of poor mental health outcomes.