title: Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda.
abstract: 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.
authors.affiliation: Center for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; School of Foreign Service, Georgetown University, Washington, DC, United States. Electronic address: em1061@georgetown.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Mendenhall
authors.affiliation: Center for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: De Silva
authors.affiliation: Center for Global Mental Health, Institute of Psychiatry, King's College London, London, United Kingdom; Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
authors.affiliation: University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Inge
authors.initials: I
authors.lastname: Petersen
authors.affiliation: Centre for Mental Health, Public Health Foundation of India, New Delhi, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Shidhaye
authors.affiliation: Center for Global Mental Health, Institute of Psychiatry, King's College London, London, United Kingdom; HealthNet TPO, Amsterdam, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: Jordans
authors.affiliation: TPO Nepal, Kathmandu, Nepal.
authors.forename: Nagendra
authors.initials: N
authors.lastname: Luitel
authors.affiliation: Makerere University, Kampala, Uganda.
authors.forename: Joshua
authors.initials: J
authors.lastname: Ssebunnya
authors.affiliation: Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia; King's College London, Institute of Psychiatry, Department of Psychological Medicine, the Affective Disorders Research Group, London, United Kingdom.
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
authors.affiliation: Center for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centre for Mental Health, Public Health Foundation of India, New Delhi, India; Sangath, Goa, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.affiliation: Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Heath, University of Cape Town, Cape Town, South Africa; Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Mark
authors.initials: M
authors.lastname: Tomlinson
authors.affiliation: Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Heath, University of Cape Town, Cape Town, South Africa.
authors.forename: Crick
authors.initials: C
authors.lastname: Lund
mesh_terms: D000349:Africa; D001211:Asia, Western; D003150:Community Health Workers / Q000458:organization & administration*; D003906:Developing Countries; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007318:Inservice Training; D007407:Interviews as Topic; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D000078329:Workforce
keywords: Acceptability; Feasibility; Global mental health; Low- and middle-income countries; Mental health services; Task-sharing; Task-shifting
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