Skip to main content

Advertisement

SpringerLink
Log in

Innovative Models in Mental Health Delivery Systems: Task Sharing Care with Non-specialist Providers to Close the Mental Health Treatment Gap

  • Public Policy and Public Health (G Norquist, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Most people do not have access to adequate mental health care, and lack of skilled human resources is a major factor. We provide a narrative review of approaches to implementing task sharing—engaging non-specialist providers—to deliver mental health care.

Recent Findings

There is strong evidence both for the effectiveness of task sharing as a means of delivering care for a range of conditions across settings and for the effectiveness of non-specialist providers and health workers in delivering elements of culturally adapted psychosocial and psychological interventions for common and severe mental disorders. Key approaches to facilitate task sharing of care include balanced care, collaborative care, sustained training and supervision, use of trans-diagnostic interventions based on a dimensional approach to wellness and illness, and the use of emerging digital technologies.

Summary

Non-specialist providers and health workers are well positioned to deliver evidence-based interventions for mental disorders, and a variety of delivery approaches can support, facilitate, and sustain this innovation. These approaches should be used, and evaluated, to increase access to mental health services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet. 2007;370(9590):878–89.

    PubMed  Google Scholar 

  2. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1575–86.

    PubMed  Google Scholar 

  3. Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800.

    Google Scholar 

  4. Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry. 2016;3(2):171–8.

    PubMed  Google Scholar 

  5. Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1260–344.

    Google Scholar 

  6. Alonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, et al. Treatment gap for anxiety disorders is global: results of the World Mental Health Surveys in 21 countries. Depress Anxiety. 2018;35(3):195–208.

    PubMed  PubMed Central  Google Scholar 

  7. Vigo DV, Kestel D, Pendakur K, Thornicroft G, Atun R. Disease burden and government spending on mental, neurological, and substance use disorders, and self-harm: cross-sectional, ecological study of health system response in the Americas. Lancet Public Health [Internet]. 2018 Nov [cited 2018 Dec 29]; Available from: https://linkinghub.elsevier.com/retrieve/pii/S2468266718302032

  8. Saxena S. Disparity between burden and budget for mental health. Lancet Public Health [Internet]. 2018 Nov [cited 2018 Dec 29]; Available from: https://linkinghub.elsevier.com/retrieve/pii/S246826671830238X

  9. Saxena S, Funk M, Chisholm D. WHO’s Mental Health Action Plan 2013-2020: what can psychiatrists do to facilitate its implementation? World Psychiatry. 2014;13(2):107–9.

    PubMed  PubMed Central  Google Scholar 

  10. Patel V. Universal health coverage for schizophrenia: a global mental health priority. Schizophr Bull. 2016;42(4):885–90.

    PubMed  Google Scholar 

  11. Eaton J, Ryan G. Making universal health coverage a reality: bridging the gap between Global Mental Health and practical integration into local health systems. Epidemiol Psychiatr Sci. 2017;26(03):245–7.

    CAS  PubMed  Google Scholar 

  12. Harris M, Bhatti Y, Darzi A. Does the country of origin matter in health care innovation diffusion? JAMA. 2016;315(11):1103.

    CAS  PubMed  Google Scholar 

  13. Harris M, Weisberger E, Silver D, Macinko J. ‘They hear “Africa” and they think that there can’t be any good services’ – perceived context in cross-national learning: a qualitative study of the barriers to Reverse Innovation. Glob Health [Internet]. 2015 Dec [cited 2018 Dec 29];11(1). Available from: http://www.globalizationandhealth.com/content/11/1/45

  14. Harris M, Weisberger E, Silver D, Dadwal V, Macinko J. That’s not how the learning works – the paradox of reverse innovation: a qualitative study. Glob Health [Internet]. 2016 Dec [cited 2018 Dec 29];12(1). Available from: https://doi.org/10.1186/s12992-016-0175-7

  15. Tran V-T, Ravaud P. Frugal innovation in medicine for low resource settings. BMC Med [Internet]. 2016 Dec [cited 2018 Dec 29];14(1). Available from: https://doi.org/10.1186/s12916-016-0651-1

  16. Binagwaho A, Nutt CT, Mutabazi V, Karema C, Nsanzimana S, Gasana M, et al. Shared learning in an interconnected world: innovations to advance global health equity. Glob Health. 2013;9(1):37.

    Google Scholar 

  17. Syed SB, Dadwal V, Martin G. Reverse innovation in global health systems: towards global innovation flow. Glob Health. 2013;9(1):36.

    Google Scholar 

  18. Dandonoli P. Open innovation as a new paradigm for global collaborations in health. Glob Health. 2013;9(1):41.

    Google Scholar 

  19. •• Singla DR, Kohrt BA, Murray LK, Anand A, Chorpita BF, Patel V. Psychological treatments for the world: lessons from low- and middle-income countries. Annu Rev Clin Psychol. 2017;13(1):149–81 An important review of psychological treatments that looks at the essential elements of care that are used and reflected in the literature. This review provides important information in the quest for adaptation of common elements of psychological treatments across settings.

    PubMed  PubMed Central  Google Scholar 

  20. Singla DR, Raviola G, Patel V. Scaling up psychological treatments for common mental disorders: a call to action. World Psychiatry. 2018;17(2):226–7.

    PubMed  PubMed Central  Google Scholar 

  21. Lehmann U, Sanders D. Community health workers: what do we know about them? The state of the evidence on programmes, activities, costs an impact on health outcomes of using community health workers [Internet]. World Health Organization; 2007 [cited 2018 Dec 17]. Available from: https://www.hrhresourcecenter.org/node/1587.html

  22. Palazuelos D, Ellis K, DaEun ID, Peckarsky M, Schwarz D, Bertrand Farmer D, et al. 5-SPICE: the application of an original framework for community health worker program design, quality improvement and research agenda setting. Glob Health Action. 2013;6(1):19658.

    PubMed  Google Scholar 

  23. Kok MC, Dieleman M, Taegtmeyer M, Broerse JE, Kane SS, Ormel H, et al. Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy Plan. 2015;30(9):1207–27.

    PubMed  Google Scholar 

  24. McCollum R, Gomez W, Theobald S, Taegtmeyer M. How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review. BMC Public Health [Internet]. 2016 Dec [cited 2018 Dec 29];16(1). Available from: https://doi.org/10.1186/s12889-016-3043-8

  25. Payne J, Razi S, Emery K, Quattrone W, Tardif-Douglin M. Integrating community health workers (CHWs) into health care organizations. J Community Health. 2017;42(5):983–90.

    PubMed  Google Scholar 

  26. Zachariah R, Ford N, Philips M, S. Lynch, Massaquoi M, Janssens V, et al. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg 2009;103(6):549–558.

    CAS  PubMed  Google Scholar 

  27. Crowley T, Mayers P. Trends in task shifting in HIV treatment in Africa: effectiveness, challenges and acceptability to the health professions. Afr J Prim Health Care Fam Med [Internet]. 2015 Jul 30 [cited 2018 Dec 30];7(1). Available from: https://phcfm.org/index.php/phcfm/article/view/807

  28. Callaghan M, Ford N, Schneider H. A systematic review of task-shifting for HIV treatment and care in Africa. Hum Resour Health [Internet]. 2010 Dec [cited 2018 Feb 7];8(1). Available from: https://doi.org/10.1186/1478-4491-8-8

  29. Raven J, Akweongo P, Baba A, Baine SO, Sall MG, Buzuzi S, et al. Using a human resource management approach to support community health workers: experiences from five African countries. Hum Resour Health [Internet]. 2015 Dec [cited 2018 Dec 29];13(1). Available from: https://doi.org/10.1186/s12960-015-0034-2

  30. Kok MC, Broerse JEW, Theobald S, Ormel H, Dieleman M, Taegtmeyer M. Performance of community health workers: situating their intermediary position within complex adaptive health systems. Hum Resour Health [Internet]. 2017 Dec [cited 2018 Dec 29];15(1). Available from: https://doi.org/10.1186/s12960-017-0234-z

  31. Vaughan K, Kok MC, Witter S, Dieleman M. Costs and cost-effectiveness of community health workers: evidence from a literature review. Hum Resour Health [Internet]. 2015 Dec [cited 2018 Dec 29];13(1). Available from: https://doi.org/10.1186/s12960-015-0070-y

  32. Maier CB. The role of governance in implementing task-shifting from physicians to nurses in advanced roles in Europe, U.S., Canada, New Zealand and Australia. Health Policy. 2015;119(12):1627–35.

    PubMed  Google Scholar 

  33. • Ballard M, Schwartz R, Johnson A, Church S, Palazuelos D, McCormick L, et al. Practitioner expertise to optimize community health systems: harnessing operational insight [Internet]. Sall Family Foundation; 2017 [cited 2018 Dec 17]. Available from: https://www.chwimpact.org A summary of key findings from the community health worker literature. Field-based experiences over the past two decades of caring for problems such as HIV and tuberculosis with engagement of community health workers are useful for those in the field of psychiatry looking to task share in mental health services..

  34. Harding TW, Chrusciel TL. The use of psychotropic drugs in developing countries. Bulletin of the World Health Organization. Vol. 52. 1975.

  35. Whitley R. Global Mental Health: concepts, conflicts and controversies. Epidemiol Psychiatr Sci. 2015;24:285–91.

    PubMed  Google Scholar 

  36. Chisholm D, Flisher AJ, Lund C, Patel V, Saxena S, Thornicroft G, et al. Scale up services for mental disorders: a call for action. Lancet. 2007;370(9594):1241–52.

    CAS  PubMed  Google Scholar 

  37. Patel V, Araya R, Chatterjee S, Chisholm D, Cohen A, De Silva M, et al. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet. 2007;370(9591):991–1005.

    PubMed  Google Scholar 

  38. Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, et al. No health without mental health. Lancet. 2007;370(9590):859–77.

    PubMed  Google Scholar 

  39. Horton R. Launching a new movement for mental health. Lancet. 2007;370(9590):806.

    PubMed  Google Scholar 

  40. Patel V, Boyce N, Collins PY, Saxena S, Horton R. A renewed agenda for global mental health. Lancet. 2011;378(9801):1441–2.

    PubMed  PubMed Central  Google Scholar 

  41. Kakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, Morris J, et al. Human resources for mental health care: current situation and strategies for action. Lancet. 2011;378:1654–63.

    PubMed  Google Scholar 

  42. Collins P, Patel V, Joestl S, March D, Insel T, Daar A, et al. Grand challenges in global mental health. Nature. 2011;475:27–30.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Collins PY, Insel TR, Chockalingam A, Daar A, Maddox YT. Grand challenges in global mental health: integration in research, policy, and practice. PLoS Med. 2013;10(4):e1001434.

    PubMed  PubMed Central  Google Scholar 

  44. Ngo VK, Rubinstein A, Ganju V, Kanellis P, Loza N, Rabadan-Diehl C, et al. Grand challenges: integrating mental health care into the non-communicable disease agenda. PLoS Med. 2013;10(5):e1001443.

    PubMed  PubMed Central  Google Scholar 

  45. Rahman A, Surkan PJ, Cayetano CE, Rwagatare P, Dickson KE. Grand challenges: integrating maternal mental health into maternal and child health programmes. PLoS Med. 2013;10(5):e1001442.

    PubMed  PubMed Central  Google Scholar 

  46. Kaaya S, Eustache E, Lapidos-Salaiz I, Musisi S, Psaros C, Wissow L. Grand challenges: improving HIV treatment outcomes by integrating interventions for co-morbid mental illness. PLoS Med. 2013;10(5):e1001447.

    PubMed  PubMed Central  Google Scholar 

  47. Patel V, Belkin GS, Chockalingam A, Cooper J, Saxena S, Unützer J. Grand challenges: integrating mental health services into priority health care platforms. PLoS Med. 2013;10(5):e1001448.

    PubMed  PubMed Central  Google Scholar 

  48. World Health Organization, Geneva S, Chisholm D. Investing in mental health. East Mediterr Health J. 2015;12(7):531–4.

    Google Scholar 

  49. Layard R, Clark DM. Why more psychological therapy would cost nothing. Front Psychol [Internet]. 2015 Nov 25 [cited 2018 Dec 30];6. Available from: https://doi.org/10.3389/fpsyg.2015.01713/abstract

  50. • Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P, et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet. 2016;3:415–24. The authors have shown the cost-effectiveness of care for depression and anxiety, integrating information on the mobilization of non-specialist health workers.

    PubMed  Google Scholar 

  51. Strand KB, Chisholm D, Fekadu A, Johansson KA. Scaling-up essential neuropsychiatric services in Ethiopia: a cost-effectiveness analysis. Health Policy Plan. 2016;31(4):504–13.

    PubMed  Google Scholar 

  52. Horton S, Gelband H, Jamison D, Levin C, Nugent R, Watkins D. Ranking 93 health interventions for low- and middle-income countries by cost-effectiveness. Smith Fawzi MC, editor. PLOS ONE. 2017;12(8):e0182951.

  53. Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010;376(9758):2086–95.

    PubMed  PubMed Central  Google Scholar 

  54. Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, et al. Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months. Br J Psychiatry. 2011;199(6):459–66.

    PubMed  PubMed Central  Google Scholar 

  55. Lund C, Tomlinson M, Silva MD, Fekadu A, Shidhaye R, Jordans M, et al. PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med. 2012;9(12):e1001359.

    PubMed  PubMed Central  Google Scholar 

  56. Davies T, Lund C. Integrating mental health care into primary care systems in low- and middle-income countries: lessons from PRIME and AFFIRM. Glob Ment Health [Internet]. 2017 [cited 2018 Dec 30];4. Available from: https://www.cambridge.org/core/product/identifier/S2054425117000036/type/journal_article

  57. Patel V, Weobong B, Nadkarni A, Weiss HA, Anand A, Naik S, et al. The effectiveness and cost-effectiveness of lay counsellor-delivered psychological treatments for harmful and dependent drinking and moderate to severe depression in primary care in India: PREMIUM study protocol for randomized controlled trials. Trials. 2014;15(1):101.

    PubMed  PubMed Central  Google Scholar 

  58. Semrau M, Evans-Lacko S, Alem A, Ayuso-Mateos JL, Chisholm D, Gureje O, et al. Strengthening mental health systems in low- and middle-income countries: the Emerald programme. BMC Med [Internet]. 2015 Dec [cited 2018 Dec 29];13(1). Available from: https://doi.org/10.1186/s12916-015-0309-4

  59. van Ginneken N, Tharyan P, Lewin S, Rao GN, Meera S, Pian J, et al. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2013 [cited 2016 Oct 13]. Available from: https://doi.org/10.1002/14651858.CD009149.pub2

  60. Bolton P, Bass J, Neugebauer R, Verdeli H, Clougherty KF, Wickramaratne P, et al. Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. JAMA. 2003;289(23):3117.

    PubMed  Google Scholar 

  61. Verdeli H, Clougherty K, Bolton P, Speelman L, Ndogoni L, Bass J, et al. Adapting group interpersonal psychotherapy for a developing country: experience in rural Uganda. World Psychiatry. 2003;2(2):114–20.

    PubMed  PubMed Central  Google Scholar 

  62. de Mello MF, de Jesus MJ, Bacaltchuk J, Verdeli H, Neugebauer R. A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. Eur Arch Psychiatry Clin Neurosci. 2005;255(2):75–82.

    PubMed  Google Scholar 

  63. Verdeli H, Clougherty K, Onyango G, Lewandowski E, Speelman L, Betancourt TS, et al. Group interpersonal psychotherapy for depressed youth in IDP camps in northern Uganda: adaptation and training. Child Adolesc Psychiatr Clin N Am. 2008;17(3):605–24.

    PubMed  Google Scholar 

  64. van Hees MLJM, Rotter T, Ellermann T, Evers SMAA. The effectiveness of individual interpersonal psychotherapy as a treatment for major depressive disorder in adult outpatients: a systematic review. BMC Psychiatry [Internet]. 2013 Dec [cited 2019 Feb 3];13(1). Available from: https://doi.org/10.1186/1471-244X-13-22

  65. Mutamba BB, Kane JC, de Jong JTVM, Okello J, Musisi S, Kohrt BA. Psychological treatments delivered by community health workers in low-resource government health systems: effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda. Psychol Med. 2018;48(15):2573–83.

    PubMed  PubMed Central  Google Scholar 

  66. Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet. 2008;372(9642):902–9.

    PubMed  PubMed Central  Google Scholar 

  67. Sikander S, Maselko J, Zafar S, Haq Z, Ahmad I, Ahmad M, et al. Cognitive-behavioral counseling for exclusive breastfeeding in rural pediatrics: a cluster RCT. Pediatrics. 2015;135(2):e424–31.

    PubMed  Google Scholar 

  68. Chiumento A, Hamdani SU, Khan MN, Dawson K, Bryant RA, Sijbrandij M, et al. Evaluating effectiveness and cost-effectiveness of a group psychological intervention using cognitive behavioural strategies for women with common mental disorders in conflict-affected rural Pakistan: study protocol for a randomised controlled trial. Trials [Internet]. 2017 Apr 26 [cited 2018 May 10];18. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405533/

  69. Chowdhary N, Anand A, Dimidjian S, Shinde S, Weobong B, Balaji M, et al. The Healthy Activity Program lay counsellor delivered treatment for severe depression in India: systematic development and randomised evaluation. Br J Psychiatry. 2016;208(4):381–8.

    PubMed  PubMed Central  Google Scholar 

  70. Patel V, Weobong B, Weiss HA, Anand A, Bhat B, Katti B, et al. The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. Lancet. 2017;389(10065):176–85.

    PubMed  PubMed Central  Google Scholar 

  71. • Chibanda D, Verhey R, Munetsi E, Rusakaniko S, Cowan F, Lund C. Scaling up interventions for depression in sub-Saharan Africa: lessons from Zimbabwe. Glob Ment Health [Internet]. 2016 [cited 2018 Dec 30];3. Available from: http://www.journals.cambridge.org/abstract_S205442511600008X This summary describes the outcomes of an initiative in which non-specialist health workers have been effectively treating depression at scale, with lessons for those in higher-income settings.

  72. World Health Organization. Thinking healthy: a manual for psychosocial management of perinatal depression (WHO generic field-trial version 1.0) [Internet]. Geneva, WHO; 2015 [cited 2017 Jan 18]. Available from: http://www.who.int/mental_health/maternal-child/thinking_healthy/en/

  73. Sikander S, Lazarus A, Bangash O, Fuhr DC, Weobong B, Krishna RN, et al. The effectiveness and cost-effectiveness of the peer-delivered Thinking Healthy Programme for perinatal depression in Pakistan and India: the SHARE study protocol for randomised controlled trials. Trials [Internet]. 2015 Dec [cited 2016 Oct 13];16(1). Available from: https://doi.org/10.1186/s13063-015-1063-9

  74. Turner EL, Sikander S, Bangash O, Zaidi A, Bates L, Gallis J, et al. The effectiveness of the peer delivered Thinking Healthy Plus (THPP+) Programme for maternal depression and child socio-emotional development in Pakistan: study protocol for a three-year cluster randomized controlled trial. Trials [Internet]. 2016 Dec [cited 2018 Dec 29];17(1). Available from: https://doi.org/10.1186/s13063-016-1530-y

  75. Chatterjee S, Pillai A, Jain S, Cohen A, Patel V. Outcomes of people with psychotic disorders in a community-based rehabilitation programme in rural India. Br J Psychiatry. 2009;195(5):433–9.

    PubMed  PubMed Central  Google Scholar 

  76. • Hanlon C. Next steps for meeting the needs of people with severe mental illness in low- and middle-income countries. Epidemiol Psychiatr Sci. 2017 26(04):348–54. This review is helpful in providing a landscape of next steps with regard to needed research on task sharing for severe mental disorders.

    PubMed  Google Scholar 

  77. Dias A, Azariah F, Anderson SJ, Sequeira M, Cohen A, Morse JQ, et al. Effect of a lay counselor intervention on prevention of major depression in older adults living in low- and middle-income countries: a randomized clinical trial. JAMA Psychiatry [Internet]. 2018 Nov 7 [cited 2018 Dec 3]; Available from: https://doi.org/10.1001/jamapsychiatry.2018.3048

    PubMed  Google Scholar 

  78. Thirthalli J, Sivakumar PT, Gangadhar BN. Preventing late-life depression through task sharing: scope of translating evidence to practice in resource-scarce settings. JAMA Psychiatry. 2019;76(1):7.

    Google Scholar 

  79. Nadkarni A, Weobong B, Weiss HA, McCambridge J, Bhat B, Katti B, et al. Counselling for Alcohol Problems (CAP), a lay counsellor-delivered brief psychological treatment for harmful drinking in men, in primary care in India: a randomised controlled trial. Lancet. 2017;389(10065):186–95.

    PubMed  PubMed Central  Google Scholar 

  80. Divan G, Vajaratkar V, Cardozo P, Huzurbazar S, Verma M, Howarth E, et al. The Feasibility and Effectiveness of PASS Plus, A lay health worker delivered comprehensive intervention for autism spectrum disorders: pilot RCT in a rural low and middle income country setting: comprehensive intervention for lay-health worker. Autism Res [Internet]. 2018 Aug 10 [cited 2018 Dec 13]; Available from: https://doi.org/10.1002/aur.1978

    PubMed  Google Scholar 

  81. • Cuijpers P, Karyotaki E, Reijnders M, Purgato M, Barbui C. Psychotherapies for depression in low- and middle-income countries: a meta-analysis. World Psychiatry. 2018;17(1):90–101 This meta-analysis concludes that caring for depression in low- and middle-income countries is shown to be more effective than in higher-income countries. This helps to strengthen the argument that depression exists across all settings, and it is treatable across all settings.

    PubMed  PubMed Central  Google Scholar 

  82. Tol WA. Stemming the tide: promoting mental health and preventing mental disorders in low- and middle-income countries. Glob Ment Health [Internet]. 2015 [cited 2018 Dec 30];2. Available from: http://www.journals.cambridge.org/abstract_S2054425115000096

  83. Petersen I, Evans-Lacko S, Semrau M, Barry MM, Chisholm D, Gronholm P, et al. Promotion, prevention and protection: interventions at the population- and community-levels for mental, neurological and substance use disorders in low- and middle-income countries. Int J Ment Heal Syst. 2016;10:30.

    Google Scholar 

  84. World Health Organization. mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings [Internet]. Geneva: World Health Organization; 2010 [cited 2 Feb 2019]. Available from: https://www.who.int/mental_health/publications/mhGAP_intervention_guide/en/

  85. World Health Organization. mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings–version 2.0 [Internet]. Geneva: World Health Organization; 2016 [cited 2 Feb 2019]. Available from: https://www.who.int/mental_health/mhgap/mhGAP_intervention_guide_02/en/

  86. World Health Organization and UNHCR. mhGAP Humanitarian Intervention Guide (mhGAP-HIG): clinical management of mental, neurological and substance use conditions in humanitarian emergencies [Internet]. Geneva: World Health Organization; 2015 [cited 2 Feb 2019]. Available from: https://www.who.int/mental_health/publications/mhgap_hig/en/.

  87. Robiner WN. The mental health professions: workforce supply and demand, issues, and challenges. Clin Psychol Rev. 2006;26(5):600–25.

    PubMed  Google Scholar 

  88. Thomas KC, Ellis AR, Konrad TR, Holzer CE, Morrissey JP. County-level estimates of mental health professional shortage in the United States 2009;60(10):6.

  89. • Kazdin AE. Addressing the treatment gap: a key challenge for extending evidence-based psychosocial interventions. Behav Res Ther. 2017;88:7–18 This succinct commentary provides another perspective in innovation in mental health services and task sharing as a potentially important tool for the field of psychiatry.

    PubMed  Google Scholar 

  90. Sashidharan SP, White R, Mezzina R, Jansen S, Gishoma D. Global mental health in high-income countries. Br J Psychiatry. 2016;209(01):3–5.

    CAS  PubMed  Google Scholar 

  91. Grant KL, Simmons MB, Davey CG. Three nontraditional approaches to improving the capacity, accessibility, and quality of mental health services: an overview. Psychiatr Serv. 2018;69(5):508–16.

    PubMed  Google Scholar 

  92. Daar AS, Jacobs M, Wall S, Groenewald J, Eaton J, Patel V, et al. Declaration on mental health in Africa: moving to implementation. Glob Health Action [Internet]. 2014 Jun 13 [cited 2016 Oct 13];7(0). Available from: http://www.globalhealthaction.net/index.php/gha/article/view/24589

    PubMed  Google Scholar 

  93. Freeman M. Global mental health in low and middle income, especially African countries. Epidemiol Psychiatr Sci. 2016;25(06):503–5.

    CAS  PubMed  Google Scholar 

  94. • Jack HE, Arabadjis SD, Sun L, Sullivan EE, Phillips RS. Impact of community health workers on use of healthcare services in the United States: a systematic review. J Gen Intern Med. 2017;32(3):325–44 This review updates us on the state of the evidence with regard to the engagement of non-specialist providers in US health care.

    PubMed  Google Scholar 

  95. McCoy KT. Achieving full scope of practice readiness using evidence for psychotherapy teaching in web and hybrid approaches in psychiatric mental health advanced practice nursing education. Perspect Psychiatr Care. 2018;54(1):74–83.

    PubMed  Google Scholar 

  96. Kverno K, Kozeniewski K. Expanding rural access to mental health care through online postgraduate nurse practitioner education: J Am Assoc Nurse Pract 2016;28(12):646–651.

    PubMed  Google Scholar 

  97. Pearlman SA. The Patient Protection and Affordable Care Act: impact on mental health services demand and provider availability. J Am Psychiatric Nurses Assoc. 2013;19(6):327–34.

    Google Scholar 

  98. • Barnett ML, Gonzalez A, Miranda J, Chavira DA, Lau AS. Mobilizing community health workers to address mental health disparities for underserved populations: a systematic review. Adm Policy Ment Health Ment Health Serv Res. 2018;45(2):195–211 This is a helpful review on non-specialist providers engaged in mental health care.

    Google Scholar 

  99. •• Barnett ML, Lau AS, Miranda J. Lay health worker involvement in evidence-based treatment delivery: a conceptual model to address disparities in care. Annu Rev Clin Psychol. 2018;14(1):185–208 The authors have looked at the literature and proposed the various ways that non-specialist providers can be engaged in mental health care delivery in a task-shared system.

    PubMed  PubMed Central  Google Scholar 

  100. •• Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The Lancet Commission on global mental health and sustainable development. Lancet. 2018;392(10157):1553–98 This is now essential reading for seeking an update on the state of global mental health and next steps in closing the global mental health treatment gap.

    PubMed  Google Scholar 

  101. Thornicroft G, Tansella M. The balanced care model for global mental health. Psychol Med. 2013;43(04):849–63.

    CAS  PubMed  Google Scholar 

  102. Petersen I, Evans-Lacko S, Semrau M, Barry M, Chisholm D, Gronholm P, et al. Population and community platform interventions. In: Patel V, Chisholm D, Dua T, Laxminarayan R, Medina-Mora ME, editors. Mental, neurological, and substance use disorders. Disease control priorities, third edition, volume 4. Washington, DC: World Bank; 2015. https://doi.org/10.1596/978-1-4648-0426-7.

  103. Shidhaye R, Lund C, Chisholm D. Health care platform interventions. In: Patel V, Chisholm D, Dua T, Laxminarayan R, Medina-Mora ME, editors. Mental, neurological, and substance use disorders. Disease control priorities, third edition, volume 4. Washington, DC: World Bank; 2015. https://doi.org/10.1596/978-1-4648-0426-7.

  104. Chwastiak L, Vanderlip E, Katon W. Treating complexity: collaborative care for multiple chronic conditions. Int Rev Psychiatry. 2014;26(6):638–47.

    PubMed  Google Scholar 

  105. • Thornicroft G, Ahuja S, Barber S, Chisholm D, Collins PY, Docrat S, et al. Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries. Lancet Psychiatry [Internet]. 2018 Nov [cited 2018 Dec 18]; Available from: https://linkinghub.elsevier.com/retrieve/pii/S2215036618302980 This is a useful update on concepts of integrated care and their application to those living with severe mental illness.

  106. • Kroenke K, Unutzer J. Closing the false divide: sustainable approaches to integrating mental health services into primary care. J Gen Intern Med. 2017; 32(4):404–10. This is an important commentary from investigators who have elaborated collaborative, stepped care for depression in the USA, with application of key concepts in other settings.

    PubMed  PubMed Central  Google Scholar 

  107. Bower P, Gilbody S. Stepped care in psychological therapies: access, effectiveness and efficiency—narrative literature review. Br J Psychiatry. 2005;186:11–7.

    PubMed  Google Scholar 

  108. Balaji M, Chatterjee S, Koschorke M, Rangaswamy T, Chavan A, Dabholkar H, et al. The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India. BMC Health Serv Res. 2012;12:42.

    PubMed  PubMed Central  Google Scholar 

  109. Hanlon C, Luitel NP, Kathree T, Murhar V, Shrivasta S, Medhin G, et al. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. Montazeri A, editor. PLoS One. 2014;9(2):e88437.

    PubMed  PubMed Central  Google Scholar 

  110. Patel V, Chatterji S. Integrating mental health in care for noncommunicable diseases: an imperative for person-centered care. Health Aff (Millwood). 2015;34(9):1498–505.

    Google Scholar 

  111. Oosterbaan DB, Verbraak MJPM, Terluin B, Hoogendoorn AW, Peyrot WJ, Muntingh A, et al. Collaborative stepped care v. care as usual for common mental disorders: 8-month, cluster randomised controlled trial. Br J Psychiatry. 2013;203(2):132–9.

    PubMed  Google Scholar 

  112. Beck A, Boggs JM, Alem A, Coleman KJ, Rossom RC, Neely C, et al. Large-scale implementation of collaborative care management for depression and diabetes and/or cardiovascular disease. J Am Board Fam Med. 2018;31(5):702–11.

    PubMed  Google Scholar 

  113. • Sørensen CW, Bæk O, Kallestrup P, Carlsson J. Integrating mental health in primary healthcare in low-income countries: changing the future for people with mental disorders. Nord J Psychiatry. 2017;71(2):151–7 This is a concise review of challenges and opportunities related to mental health integration in primary care.

    PubMed  Google Scholar 

  114. Gray WK, Paddick SM, Collingwood C, Kisoli A, Mbowe G, Mkenda S, et al. Community validation of the IDEA study cognitive screen in rural Tanzania: community validation of the IDEA cognitive screen. Int J Geriatr Psychiatry. 2016;31(11):1199–207.

    PubMed  Google Scholar 

  115. Subba P, Luitel NP, Kohrt BA, Jordans MJD. Improving detection of mental health problems in community settings in Nepal: development and pilot testing of the community informant detection tool. Confl Health [Internet]. 2017 Dec [cited 2018 Dec 29];11(1). Available from: https://doi.org/10.1186/s13031-017-0132-y

  116. Stone L, Heward J, Paddick S-M, Dotchin CL, Walker RW, Collingwood C, et al. Screening for instrumental activities of daily living in sub-Saharan Africa: a balance between task shifting, simplicity, brevity, and training. J Geriatr Psychiatry Neurol. 2018;31(5):248–55.

    PubMed  Google Scholar 

  117. Diez-Canseco F, Toyama M, Ipince A, Perez-Leon S, Cavero V, Araya R, et al. Integration of a technology-based mental health screening program into routine practices of primary health care services in Peru (the Allillanchu Project): development and implementation. J Med Internet Res. 2018;20(3):e100.

    PubMed  PubMed Central  Google Scholar 

  118. Murray LK, Dorsey S, Bolton P, Jordans MJ, Rahman A, Bass J, et al. Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers. Int J Ment Heal Syst. 2011;5:30.

    Google Scholar 

  119. Armstrong G, Kermode M, Raja S, Suja S, Chandra P, Jorm AF. A mental health training program for community health workers in India: impact on knowledge and attitudes. Int J Ment Heal Syst. 2011;5(1):17.

    Google Scholar 

  120. Juen B, Siller H, Lindenthal M, Snider L, Nielsen M, Muff ML, et al. Lay counselling in humanitarian organisations: a field report on developing training materials for lay counsellors. Intervention. 2013;11(1):77–88.

    Google Scholar 

  121. Edmunds JM, Beidas RS, Kendall PC. Dissemination and implementation of evidence-based practices: training and consultation as implementation strategies. Clin Psychol Sci Pract. 2013;20(2):152–65.

    Google Scholar 

  122. Kohrt BA, Marienfeld CB, Panter-Brick C, Tsai AC, Wainberg ML. Global mental health: five areas for value-driven training innovation. Acad Psychiatry. 2016;40(4):650–8.

    PubMed  PubMed Central  Google Scholar 

  123. Cooper Z, Doll H, Bailey-Straebler S, Bohn K, de Vries D, Murphy R, et al. Assessing therapist competence: development of a performance-based measure and its comparison with a web-based measure. JMIR Ment Health. 2017;4(4):e51.

    PubMed  PubMed Central  Google Scholar 

  124. • Fairburn CG, Allen E, Bailey-Straebler S, O’Connor ME, Cooper Z. Scaling up psychological treatments: a countrywide test of the online training of therapists. J Med Internet Res. 2017;19(6):e214 This is an interesting and important study illustrating the use of technology to solve psychotherapy supervision challenges in a higher-income setting.

    PubMed  PubMed Central  Google Scholar 

  125. •• Kohrt B, Asher L, Bhardwaj A, Fazel M, Jordans M, Mutamba B, et al. The role of communities in mental health care in low- and middle-income countries: a meta-review of components and competencies. Int J Environ Res Public Health. 2018;15(6):1279 An important review of components and competencies related to the mobilization of non-specialist providers in the care of mental disorders—the where, what, who, and how of community mental health care delivery. This review provides important information in the quest for the effective mobilization of non-specialist providers to deliver psychological treatments across settings.

    PubMed Central  Google Scholar 

  126. Kohrt BA, Jordans J, Mark JD, Sauharda R, Shreshta P, Luitel NP, et al. Therapist competence in global mental health: development of the ENhancing Assessment of Common Therapeutic factors (ENACT) rating scale. Behav Res Ther. 2015;69:11–21.

    PubMed  PubMed Central  Google Scholar 

  127. • Clark DM, Canvin L, Green J, Layard R, Pilling S, Janecka M. Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. Lancet. 2018;391(10121):679–86 This is an important publication related to the evidence for the effectiveness of a significant non-specialist task sharing initiative in the UK.

    PubMed  PubMed Central  Google Scholar 

  128. Improving Access to Psychological Therapies Program. IAPT Supervision and Training Resources [Internet]. Norwich: University of East Anglia; 2011 [cited 2 Feb 2019]. Available from: https://www.uea.ac.uk/medicine/departments/psychological-sciences/cognitive-behavioural-therapy-training/iapt-and-cbt-resources/iapt-supervision-training-and-resources

  129. • Patel V. Talking sensibly about depression. PLoS Med. 2017;14(4):e1002257 This is a useful and succinct description of the dimensional, staged approach described in the paper.

    PubMed  PubMed Central  Google Scholar 

  130. • Marchette LK, Weisz JR. Practitioner review: empirical evolution of youth psychotherapy toward transdiagnostic approaches. J Child Psychol Psychiatry. 2017;58(9):970–84 This review provides very helpful background regarding the concepts surrounding transdiagnostic approaches by authors who have pioneered the practice in the USA.

    PubMed  Google Scholar 

  131. Bernstein A, Chorpita BF, Daleiden EL, Ebesutani CK, Rosenblatt A. Building an evidence-informed service array: considering evidence-based programs as well as their practice elements. J Consult Clin Psychol. 2015;83(6):1085–96.

    PubMed  Google Scholar 

  132. Murray LK, Dorsey S, Haroz E, Lee C, Alsiary MM, Haydary A, et al. A common elements treatment approach for adult mental health problems in low- and middle-income countries. Cogn Behav Pract. 2014;21(2):111–23.

    PubMed  PubMed Central  Google Scholar 

  133. Kane JC, Skavenski Van Wyk S, Murray SM, Bolton P, Melendez F, Danielson CK, et al. Testing the effectiveness of a transdiagnostic treatment approach in reducing violence and alcohol abuse among families in Zambia: study protocol of the Violence and Alcohol Treatment (VATU) trial. Glob Ment Health [Internet]. 2017 [cited 2018 Dec 31];4. Available from: https://www.cambridge.org/core/product/identifier/S2054425117000103/type/journal_article

  134. Murray LK, Haroz EE, Doty SB, Singh NS, Bogdanov S, Bass J, et al. Testing the effectiveness and implementation of a brief version of the Common Elements Treatment Approach (CETA) in Ukraine: a study protocol for a randomized controlled trial. Trials [Internet]. 2018 Dec [cited 2018 Dec 29];19(1). Available from: https://doi.org/10.1186/s13063-018-2752-y

  135. Agarwal S, Perry HB, Long L-A, Labrique AB. Evidence on feasibility and effective use of mHealth strategies by frontline health workers in developing countries: systematic review. Tropical Med Int Health. 2015;20(8):1003–14.

    Google Scholar 

  136. Ruzek JI, Eric Kuhn E, Jaworski BK, Owen JE, Ramsey KM. Mobile mental health interventions following war and disaster. mHealth [Internet]. 2016 Sep 29 [cited 2018 Dec 30]; Available from: http://mhealth.amegroups.com/article/view/11903/12258

  137. Bakker D, Kazantzis N, Rickwood D, Rickard N. Mental health smartphone apps: review and evidence-based recommendations for future developments. JMIR Ment Health. 2016;3(1):e7.

    PubMed  PubMed Central  Google Scholar 

  138. Fairburn CG, Patel V. The impact of digital technology on psychological treatments and their dissemination. Behav Res Ther. 2017;88:19–25.

    PubMed  PubMed Central  Google Scholar 

  139. •• Naslund JA, Aschbrenner KA, Araya R, Marsch LA, Unützer J, Patel V, et al. Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. Lancet Psychiatry. 2017 4(6):486–500. This is a helpful review of the literature relating to use of digital technology in mental health care.

    PubMed  PubMed Central  Google Scholar 

  140. Ruzek J, Waller G, O’Connor M, Morgan KE, Bailey-Straebler S, Fairburn CG, et al. Increasing the availability of psychological treatments: a multinational study of a scalable method for training therapists. J Med Internet Res. 2018;20(6):e10386.

    Google Scholar 

  141. • Ruzek JI, Yeager CM. Internet and mobile technologies: addressing the mental health of trauma survivors in less resourced communities. Glob Ment Health [Internet]. 2017 [cited 2018 Dec 30];4. Available from: https://www.cambridge.org/core/product/identifier/S2054425117000115/type/journal_article This is a helpful review of the uses of digital technology in crises.

  142. Long L-A, Pariyo G, Kallander K. Digital technologies for health workforce development in low- and middle-income countries: a scoping review. Glob Health. 2018;6:8.

    Google Scholar 

  143. Shields-Zeeman L, Pathare S, Walters BH, Kapadia-Kundu N, Joag K. Promoting wellbeing and improving access to mental health care through community champions in rural India: the Atmiyata intervention approach. Int J Ment Heal Syst. 2017;11(1):6.

    Google Scholar 

  144. Zafar S, Sikander S, Hamdani SU, Atif N, Akhtar P, Nazir H, et al. The effectiveness of Technology-assisted Cascade Training and Supervision of community health workers in delivering the Thinking Healthy Program for perinatal depression in a post-conflict area of Pakistan – study protocol for a randomized controlled trial. Trials [Internet]. 2016 Dec [cited 2019 Feb 3];17(1). Available from: https://doi.org/10.1186/s13063-016-1308-2

  145. Chibanda D, Weiss HA, Verhey R, Simms V, Munjoma R, Rusakaniko S, et al. Effect of a primary care–based psychological intervention on symptoms of common mental disorders in Zimbabwe: a randomized clinical trial. JAMA. 2016;316(24):2618.

    PubMed  Google Scholar 

  146. Maulik PK, Kallakuri S, Devarapalli S, Vadlamani VK, Jha V, Patel A. Increasing use of mental health services in remote areas using mobile technology: a pre–post evaluation of the SMART Mental Health project in rural India. J Glob Health. 2017;7(1):010408.

    PubMed  PubMed Central  Google Scholar 

  147. Diez-Canseco F, Toyama M, Ipince A, Perez-Leon S, Cavero V, Araya R, et al. Integration of a technology-based mental health screening program into routine practices of primary health care services in Peru (the Allillanchu Project): development and implementation. J Med Internet Res. 2018;20(3):e100.

    PubMed  PubMed Central  Google Scholar 

  148. Xu DR, Gong W, Caine ED, Xiao S, Hughes JP, Ng M, et al. Lay health supporters aided by a mobile phone messaging system to improve care of villagers with schizophrenia in Liuyang, China: protocol for a randomised control trial. BMJ Open. 2016;6(1):e010120.

    PubMed  Google Scholar 

  149. Gureje O, Oladeji BD, Araya R, Montgomery AA, Kola L, Kirmayer L, et al. Expanding care for perinatal women with depression (EXPONATE): study protocol for a randomized controlled trial of an intervention package for perinatal depression in primary care. BMC Psychiatry [Internet]. 2015 Dec [cited 2019 Feb 3];15(1). Available from: https://doi.org/10.1186/s12888-015-0537-3

  150. Chibanda D. The future of psychiatry in Africa—thinking outside the box. Lancet Psychiatry. 2017;4(10):741–2.

    PubMed  Google Scholar 

  151. Ng LC, Magidson JF, Hock RS, Joska JA, Fekadu A, Hanlon C, et al. Proposed training areas for global mental health researchers. Acad Psychiatry. 2016;40(4):679–85.

    PubMed  PubMed Central  Google Scholar 

  152. • Wainberg ML, Scorza P, Shultz JM, Helpman L, Mootz JJ, Johnson KA, et al. Challenges and opportunities in Global Mental Health: a research-to-practice perspective. Curr Psychiatry Rep [Internet]. 2017 May [cited 2018 Dec 30];19(5). Available from: https://doi.org/10.1007/s11920-017-0780-z This is a helpful review of the future of research in global mental health, and the ways in which a research-to-practice perspective will have greater relevance to higher-income settings.

  153. DeSilva M, Samele C, Saxena S, Patel V, Darzi A. Policy actions to achieve integrated community-based mental health services. Health Aff (Millwood). 2014;33(9):1595–602.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA

    Giuseppe Raviola, John A. Naslund & Vikram Patel

  2. Department of Psychiatry, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Giuseppe Raviola

  3. Department of Psychiatry, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Stephanie L. Smith

Authors
  1. Giuseppe Raviola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John A. Naslund
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephanie L. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vikram Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Raviola.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Public Policy and Public Health

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Raviola, G., Naslund, J.A., Smith, S.L. et al. Innovative Models in Mental Health Delivery Systems: Task Sharing Care with Non-specialist Providers to Close the Mental Health Treatment Gap. Curr Psychiatry Rep 21, 44 (2019). https://doi.org/10.1007/s11920-019-1028-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-019-1028-x

Keywords

Search

Navigation