TY - JOUR
T1 - Acceptability and feasibility of using non-specialist health workers to deliver mental health care
T2 - Stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda
AU - Mendenhall, Emily
AU - De Silva, Mary J.
AU - Hanlon, Charlotte
AU - Petersen, Inge
AU - Shidhaye, Rahul
AU - Jordans, Mark
AU - Luitel, Nagendra
AU - Ssebunnya, Joshua
AU - Fekadu, Abebaw
AU - Patel, Vikram
AU - Tomlinson, Mark
AU - Lund, Crick
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Three-quarters of the global mental health burden exists in low- and middle-income countries (LMICs), yet the lack of mental health services in resource-poor settings is striking. Task-sharing (also, task-shifting), where mental health care is provided by non-specialists, has been proposed to improve access to mental health care in LMICs. This multi-site qualitative study investigates the acceptability and feasibility of task-sharing mental health care in LMICs by examining perceptions of primary care service providers (physicians, nurses, and community health workers), community members, and service users in one district in each of the five countries participating in the PRogramme for Improving Mental health carE (PRIME): Ethiopia, India, Nepal, South Africa, and Uganda. Thirty-six focus group discussions and 164 in-depth interviews were conducted at the pre-implementation stage between February and October 2012 with the objective of developing district level plans to integrate mental health care into primary care. Perceptions of the acceptability and feasibility of task-sharing were evaluated first at the district level in each country through open-coding and then at the cross-country level through a secondary analysis of emergent themes. We found that task-sharing mental health services is perceived to be acceptable and feasible in these LMICs as long as key conditions are met: 1) increased numbers of human resources and better access to medications; 2) ongoing structured supportive supervision at the community and primary care-levels; and 3) adequate training and compensation for health workers involved in task-sharing. Taking into account the socio-cultural context is fundamental for identifying local personnel who can assist in detection of mental illness and facilitate treatment and care as well as training, supervision, and service delivery. By recognizing the systemic challenges and sociocultural nuances that may influence task-sharing mental health care, locally-situated interventions could be more easily planned to provide appropriate and acceptable mental health care in LMICs.
AB - Three-quarters of the global mental health burden exists in low- and middle-income countries (LMICs), yet the lack of mental health services in resource-poor settings is striking. Task-sharing (also, task-shifting), where mental health care is provided by non-specialists, has been proposed to improve access to mental health care in LMICs. This multi-site qualitative study investigates the acceptability and feasibility of task-sharing mental health care in LMICs by examining perceptions of primary care service providers (physicians, nurses, and community health workers), community members, and service users in one district in each of the five countries participating in the PRogramme for Improving Mental health carE (PRIME): Ethiopia, India, Nepal, South Africa, and Uganda. Thirty-six focus group discussions and 164 in-depth interviews were conducted at the pre-implementation stage between February and October 2012 with the objective of developing district level plans to integrate mental health care into primary care. Perceptions of the acceptability and feasibility of task-sharing were evaluated first at the district level in each country through open-coding and then at the cross-country level through a secondary analysis of emergent themes. We found that task-sharing mental health services is perceived to be acceptable and feasible in these LMICs as long as key conditions are met: 1) increased numbers of human resources and better access to medications; 2) ongoing structured supportive supervision at the community and primary care-levels; and 3) adequate training and compensation for health workers involved in task-sharing. Taking into account the socio-cultural context is fundamental for identifying local personnel who can assist in detection of mental illness and facilitate treatment and care as well as training, supervision, and service delivery. By recognizing the systemic challenges and sociocultural nuances that may influence task-sharing mental health care, locally-situated interventions could be more easily planned to provide appropriate and acceptable mental health care in LMICs.
KW - Acceptability
KW - Feasibility
KW - Global mental health
KW - Low- and middle-income countries
KW - Mental health services
KW - Task-sharing
KW - Task-shifting
UR - http://www.scopus.com/inward/record.url?scp=84920410302&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2014.07.057
DO - 10.1016/j.socscimed.2014.07.057
M3 - Article
AN - SCOPUS:84920410302
SN - 0277-9536
VL - 118
SP - 33
EP - 42
JO - Social Science and Medicine
JF - Social Science and Medicine
IS - 0
ER -
