PRIME study identifies key conditions that must be met for successful task sharing in mental health care
The PRogramme for Improving Mental health carE (PRIME) has recently published research findings regarding the acceptability and feasibility of using task sharing approaches to deliver mental health care in low and middle-income countries. Task sharing involves the delivery of mental health care by general health workers (including doctors, nurses and community health workers), who are trained and supervised by mental health specialists in routine health care delivery systems. Task sharing has been widely proposed as a strategy to meet the large treatment gap for mental disorders, due to the shortage of specialists in low and middle-income countries. There are currently approximately one psychiatrist for every 2,5 million people and one psychologist for every 2 million people in Africa.
The five country qualitative research study of stakeholder perceptions of task sharing was conducted in three African countries (Ethiopia, South Africa and Uganda) and 2 Asian countries (India and Nepal) as part of the UKAID-funded PRIME research programme consortium. Stakeholders participating in the study were primary care providers (physicians, nurses, community health workers), community members and service users (patients).
The study revealed a number of key conditions that need to be met for task sharing to succeed in delivering mental health services. These included:
- Increased numbers of human resources with improved access to medication;
- Adequate training, support and compensation for health workers who take on new mental health tasks;
- Ongoing structured and supportive supervision at community and primary health care levels
The study also highlighted the importance of understanding the socio-cultural context of each country, and of identifying credible, local personnel who can assist in the detection of mental illness and can facilitate treatment and care, including training, supervision and service delivery.
Consistent with previous research (see Padmanathan and De Silva 2013), the study also identified systemic challenges which influence task sharing mental health care. These include health worker burden, training and supervision capacity, the question of remuneration and the integration of mental health care tasks into the existing health system. The PRIME study findings suggest that the support of Ministries of Health are fundamental to investing in the training of mental health specialists to provide supervision, support and referral pathways for tasking sharing to succeed.
For more information, click here to read the full paper published in the Social Science & Medicine Journal as Open Access.