Dear Editor:

I read with great interest the article by Pope, “An Overview of Medical Errors in Psychiatry, Part 1: Introduction,”1 published in the January–March 2026 issue of Innovations in Clinical Neuroscience. The author provides a timely and well-structured framework for understanding medical errors in psychiatric practice, drawing on established terminology and insurance-based clinical data. As a clinical psychologist, I commend this contribution to a topic that has historically received insufficient attention within mental health disciplines.

However, I wish to draw attention to an important dimension that the article does not address: the heightened vulnerability to medical errors in psychiatric settings within low- and middle-income countries (LMICs). The article’s foundational data, including estimates from the Institute of Medicine, malpractice liability records from Professional Risk Management Services (PRMS), and references to the Joint Commission’s sentinel event framework, are rooted exclusively in high-income, Western healthcare contexts. While these frameworks are valuable, their direct applicability to LMIC settings is limited, and this gap warrants explicit acknowledgment.

Nath and Marcus,2 cited by the author, identify systemic strain, inadequate insurance coverage, and lack of community resources as factors that increase psychiatric error. These conditions are not merely occasional stressors in LMICs; they are often the baseline reality. In many such settings, psychiatrist-to-population ratios remain critically low, task-shifting to inadequately supervised nonspecialist providers is common, electronic health records are absent or unreliable, and structured suicide risk assessment protocols are rarely formalized.3 The “systems approach” to error that the author rightly advocates for requires functioning systems as its prerequisite, a condition that cannot be assumed globally.

Furthermore, culturally mediated diagnostic errors deserve specific attention in this context. Psychiatric symptom presentation varies across cultures, and clinicians operating with limited training or culturally incongruent diagnostic tools may be more prone to errors of misdiagnosis or delayed diagnosis, the very categories author identifies as primary error domains. Stigma, which the article references in the context of drug-dosing mistakes, also operates differently and more pervasively in LMIC settings, often discouraging help-seeking until illness severity is advanced, compounding the risk of clinical error at the point of first contact.

I would encourage the authors to consider an explicit discussion of how error prevention strategies can be adapted for resource-constrained settings. This might include task-shifting frameworks with structured supervision, low-cost standardized assessment tools, and community-based safety nets as alternatives to the systems-level safeguards available in high-income settings. Such inclusion would substantially broaden the article’s impact and relevance to the global readership of this journal.

I thank the editors for the opportunity to contribute to this important conversation and look forward to the continuation of this series.

With regards,

Muqadas Fatima, MS 

Ms. Fatima is with National University of Modern Languages, Lahore, Pakistan.

Funding/financial disclosures. The authors have no relevant conflicts of interest. No funding was received for the preparation of this letter.

Correspondence. Muqadas Fatima, MS;

References

  1. Pope J. An overview of medical errors in psychiatry, part 1: introduction. Innov Clin Neurosci. 2026;23(1–3):54–55.
  2. Nath SB, Marcus SC. Medical errors in psychiatry. Harv Rev Psychiatry. 2006;14(4):204–211.
  3. Fatima M, Ilyas U. Development of Ethical Dilemma Distress Scale for Mental Health Practitioners (EDDS-MHP). Pak J Psychol Res. 2024;39(3):613–637.