Psychiatry without thresholds: Ethical and clinical lessons from low-triage systems

Area of Science:

• Global Mental Health
• Psychiatry
• Health Systems Research

Background:

• High-income countries use implicit triage pathways for psychiatric care.
• Low- and middle-income countries often lack these filters, with psychiatrists managing all patient severities.
• This absence impacts clinical judgment and prioritization hierarchies.

Purpose of the Study:

• To explore how triage functions in low-resource psychiatric settings.
• To analyze the social and clinical factors influencing patient prioritization.
• To understand the concept of "severity" as a negotiated construct.

Main Methods:

• Qualitative analysis of psychiatric practice realities in India.
• Examination of implicit and explicit triage mechanisms.
• Exploration of social, linguistic, and clinical factors in prioritization.

Main Results:

• Severity is a dynamic, socially negotiated construct in these settings.
• Urgency can be performative, influenced by social visibility and advocacy.
• Reverse triage occurs, where social factors displace clinical need.
• Language barriers can further disadvantage patients.

Conclusions:

• Triage in resource-limited settings is an ethical mechanism for balancing access and prioritization.
• Rethinking triage is crucial for equitable mental health service delivery globally.
• Socially mediated visibility impacts prioritization more than clinical urgency.