Community Mental Health Service Gatekeeping by Village Health Committees and Involuntary Hold Disparities in Rural Malawi: A Regression-Discontinuity Estimation of Lay Authorization Exposure

Village health committees in rural Malawi frequently serve as the first point of contact for families seeking care for a relative with acute psychosis, and their informal authorization practices determine whether a person enters community mental health services voluntarily or is held involuntarily. Because no primary data were collected for this analysis, the paper develops the identification strategy, formalizes the estimand, and specifies the assumptions under which the threshold discontinuity recovers a local average treatment effect. The design is calibrated against the real DHS Program indicator 'Family planning messages at community meeting or event', which across fifteen African country surveys from 2021 to 2025 has a mean of 29.733 and a standard deviation of 17.495, with Malawi at 73.40 and Mali at 6.60. This indicator serves as a proxy for the intensity of community-level health deliberation that conditions committee gatekeeping.