Community Mental Health Services Rainfall-Sensitive Subsistence Shock and Acute Care Presentation Thresholds in Malawian Districts: A Distributed-Lag Panel Estimation

Rain-fed subsistence agriculture in Malawi couples household food security to seasonal rainfall, and community mental health services are the first point of contact for acute presentations in districts where formal psychiatric beds are scarce. The framework treats acute presentation as a threshold-crossing event in a latent severity process that responds to cumulative rainfall deficits with a lag structure shaped by the agricultural calendar, coping reserves and referral pathways. Using a distributed-lag specification with district and season fixed effects, the paper derives the conditions for identifying threshold parameters separately from lag weights, and it characterises the bias that arises when threshold heterogeneity is ignored. The contribution is a testable, discipline-grounded estimation strategy for a question that current community mental health services research has posed but not formalised, and it is offered as a methodological foundation for empirical work in Malawian districts rather than as a report of estimated effects.