{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:17:20Z","timestamp":1785406640997,"version":"3.56.0"},"reference-count":14,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"unspecified","delay-in-days":96,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Camb. prisms Glob. ment. health"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Psychiatric practice in high-income countries typically relies on implicit triage pathways that filter patients through primary and stepped care before specialist review. In many low- and middle-income settings, however, psychiatrists manage the entire spectrum of distress without such filters. This absence reshapes hierarchies of severity, alters diagnostic and ethical reasoning and influences how clinical priority is determined. Drawing on practice realities from India, this article argues that severity in such systems becomes a dynamic and socially negotiated construct rather than a fixed clinical category. Without institutional thresholds, urgency may become performative: social visibility, family advocacy and the ability to articulate distress can influence prioritization more than clinical need, producing a pattern of reverse triage, in which socially mediated visibility displaces genuine urgency. Language compatibility may further intensify this dynamic, as patients unable to communicate in the clinician\u2019s working language risk remaining unheard in undifferentiated clinical spaces. As mental health systems worldwide face rising demand and limited capacity, these observations highlight triage not as exclusion but as an ethical mechanism for balancing equity of access with fairness of prioritization.<\/jats:p>","DOI":"10.1017\/gmh.2026.10201","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T07:54:43Z","timestamp":1775548483000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Psychiatry without thresholds: Ethical and clinical lessons from low-triage systems"],"prefix":"10.1017","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2577-7633","authenticated-orcid":false,"given":"Ashok","family":"Seervi","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04crdae34","id-type":"ROR","asserted-by":"publisher"}],"name":"Dr. S.N. Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indraja","family":"Sharma","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05ydkmr70","id-type":"ROR","asserted-by":"publisher"}],"name":"Pacific Medical College and Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"S2054425126102015_r5","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2025.11.007"},{"key":"S2054425126102015_r4","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20482"},{"key":"S2054425126102015_r3","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.178.4.296"},{"key":"S2054425126102015_r1","doi-asserted-by":"publisher","DOI":"10.1111\/eip.13180"},{"key":"S2054425126102015_r2","doi-asserted-by":"publisher","DOI":"10.4102\/hsag.v30i0.3015"},{"key":"S2054425126102015_r14","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.13583"},{"key":"S2054425126102015_r7","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201400351"},{"key":"S2054425126102015_r11","unstructured":"Royal College of Psychiatrists (2023) Royal College of Psychiatrists Calls for Urgent Publication of NHS Workforce Plan as Psychiatrist Numbers Stagnate. Royal College of Psychiatrists. Available at https:\/\/www.rcpsych.ac.uk\/news-and-features\/latest-news\/detail\/2023\/05\/25\/royal-college-of-psychiatrists-calls-for-urgent-publication-of-nhs-workforce-plan-as-psychiatrist-numbers-stagnate (accessed 3 January 2026)."},{"key":"S2054425126102015_r10","unstructured":"Royal College of Psychiatrists (2022) Hidden Waits Force More than Three-Quarters of Mental Health Patients to Seek Help from Emergency Services. Royal College of Psychiatrists. Available at https:\/\/www.rcpsych.ac.uk\/news-and-features\/latest-news\/detail\/2022\/10\/10\/hidden-waits-force-more-than-three-quarters-of-mental-health-patients-to-seek-help-from-emergency-services (accessed 3 January 2026)."},{"key":"S2054425126102015_r6","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(15)00094-2"},{"key":"S2054425126102015_r8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31612-X"},{"key":"S2054425126102015_r12","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20349"},{"key":"S2054425126102015_r13","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-017-0780-z"},{"key":"S2054425126102015_r9","doi-asserted-by":"publisher","DOI":"10.1177\/1178632917694350"}],"container-title":["Cambridge Prisms: Global Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2054425126102015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T06:59:45Z","timestamp":1784271585000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2054425126102015\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":14,"alternative-id":["S2054425126102015"],"URL":"https:\/\/doi.org\/10.1017\/gmh.2026.10201","relation":{"has-review":[{"id-type":"doi","id":"10.1017\/gmh.2026.10201.pr6","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2026.10201.pr7","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2026.10201.pr4","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2026.10201.pr5","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2026.10201.pr8","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2026.10201.pr2","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2026.10201.pr3","asserted-by":"object"},{"id-type":"doi","id":"10.1017\/gmh.2026.10201.pr1","asserted-by":"object"}]},"ISSN":["2054-4251"],"issn-type":[{"value":"2054-4251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial licence (http:\/\/creativecommons.org\/licenses\/by-nc\/4.0), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original article is properly cited. The written permission of Cambridge University Press or the rights holder(s) must be obtained prior to any commercial use.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e81"}}