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This study aims to evaluate how a community psychiatry model, referred to as the Mental Health Action Trust (MHAT) in India, provides decentralized care and comprehensive services to people with severe mental illness living in poverty. Using the complex adaptive system (CAS) framework, the authors aim to understand the factors that contribute to the diverse outcomes of the MHAT community mental health programme as observed in four different locations.

Four MHAT clinics were purposively chosen from two districts in Kerala. A comparative case study methodology was used to document each clinic’s MHAT services and activities, as found during field visits and interviews with staff members and volunteers.

The study shows that all four clinics met the basic aim of providing free, quality mental health care to the poorest populations, although not all aspects of the comprehensive model could be equally provided. Alignment with the MHAT vision, appropriate leadership, the relationship with partners and their level of community engagement determined the varied success between clinics.

The current study evaluation stresses that community ownership is crucial. Careful attention must be paid to the characteristics of selected partners, including their leadership styles and ability to garner resources.

Scale-ups have a crucial role in our society and economy, are known for their fast growth and high performance and undergo significant organizational change. Research on the organizational elements that ensure scale-ups sustaining high performance is limited. This empirical study aims to investigate the organizational culture in scale-ups using the Competing Values Framework, including the clan, adhocracy, the market, hierarchy cultures and its relation to performance.

Quantitative and qualitative data were collected in five scale-ups. Surveys provided data of 116 employees on organizational culture, assessed using the Organizational Culture Assessment Instrument (OCAI) and perceived performance. The aggregate outcomes and performance measures were analyzed using correlation analysis. Interviews were held with ten top managers and mirrored against the quantitative data.

The results show that top managers and employees have different perspectives on the culture scale-ups are supposed to have. Top managers perceive market culture as more and hierarchy culture as less present in their organizations than employees. The clan and adhocracy culture are positively correlated to performance and are preferred by employees. Market and hierarchy culture types are negatively correlated to performance and are least preferred by employees.

It enables scale-up leaders to specifically intervene when cultural elements are experienced by employees that will not drive performance and fit the high performance and fast-growing scale-up environment.

This study is the first that showed that organizational-wide surveys, combined with in-depth interviews, are suitable for top managers of scale-ups to diagnose the organizational culture and the effect on the organization's performance.