ACONAMI: A Case for Asian Mental Health Transformation

The global call for mental health transformation is urgent. The World Health Organization (WHO) highlights enduring gaps in governance, data, resources, and services that compromise equitable, high-quality care (WHO 2022). In Asia, these weaknesses are pronounced, stigma persists, infrastructure and workforce capacity remain inadequate, and access continues to be poor, particularly for rural and underserved populations. Post-pandemic, the OECD outlined key dimensions for reform, including person-centered care, integrated services, prevention, strong governance, and innovation (OECD 2021). Yet progress in Asia remains uneven. Preventive and promotive initiatives are limited, integration across sectors is fragmented, and digital infrastructure and human resources constrain innovation. These challenges underscore the need for regionally grounded collaboration and context-sensitive reform. The Stepped-Care Model represents one critical component of mental health system transformation. It primarily addresses three parameters: access, intensity matching, and resource optimization (Bower and Gilbody 2005). By structuring services from low-intensity options (e.g., psychoeducation and digital self-help) to specialist treatments, stepped care can improve efficiency and equity. However, it is not a complete solution. Its effectiveness depends on referral pathways, supervision, and a trained workforce, conditions that may be limited in low-income settings. Without parallel development in governance, financing, and community partnerships, stepped care alone cannot close treatment gaps (Lee and Fung 2025). Transformation also requires academic-clinical integration. Academic Clinical Programmes (ACPs) within academic health systems have proven effective in advancing quality, safety, and innovation by linking education, research, and practice (Dzau et al. 2010). Applied to mental health, ACPs can embed training, governance, and research in service delivery, cultivating a workforce skilled in evidence-based, culturally relevant care. A regional model, however, demands cross-border collaboration. Since 2017, the Asian Consortium of National Mental Health Institutions (ACONAMI), comprising Singapore's Institute of Mental Health (IMH), Japan's National Center of Neurology and Psychiatry (NCNP), and South Korea's National Center for Mental Health (NCMH), has exemplified this potential. ACONAMI unites complementary strengths across integrated care, neuroscientific research, and community rehabilitation. Building on this foundation, ACONAMI can lead the creation of an Asian Academic Clinical Programme (A-ACP) anchored in stepped-care principles and aligned with WHO and OECD priorities. Since its establishment in 2017, ACONAMI has undertaken joint benchmarking of clinical quality and safety indicators (11 domains have been selected across 3 institutions including 3-month readmission rate, average length of stay, restraint rate, and involuntary admissions), organized annual leadership exchanges and scholar attachments among IMH, NCNP, and NCMH, and convened 7 regional symposia or conferences on topics such as early psychosis, dementia, and community mental health. These tangible outputs demonstrate the consortium's capacity to translate academic collaboration into system-level learning and innovation. Importantly, this model is sustained through shared institutional responsibility: each member supports its own trainees and faculty during exchanges without cross-charging. This cost-sharing approach reduces financial barriers and supports continuity, while enabling capacity building that can extend to primary care and generalist providers, including general practitioners, to broaden reach in diverse settings. The experience of ACONAMI illustrates how cross-national academic-clinical partnerships can foster governance alignment, research collaboration, and workforce development across countries. Through structured exchanges, shared benchmarking, and joint capacity building, ACONAMI demonstrates that such synergy can indeed drive innovation and resilience. Its collective ethos and measurable outputs provide a working model for advancing an Asian approach to mental health transformation, one that is equitable, culturally grounded, and globally relevant. D.S.S.F. conceived and drafted the manuscript. Y.C. and Y.-S.K. contributed to literature synthesis and revisions. All authors approved the final version. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.