Using lay health workers to identify and manage common mental disorders using problem solving therapy through a friendship bench in a resource poor setting in Zimbabwe

Abstract Background There is a large treatment gap for common mental disorders in rural areas of low-income countries. We tested the Friendship Bench as a brief psychological intervention delivered by village health workers (VHWs) in rural Zimbabwe. Methods Rural women identified with depression in a previous trial received weekly home-based problem-solving therapy from VHWs for 6 weeks, and joined a peer-support group. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Shona Symptom Questionnaire (SSQ). Acceptability was explored through in-depth interviews and focus group discussions. The proportion of women with depression pre- and post-intervention was compared using McNemar's test. Results Ten VHWs delivered problem-solving therapy to 27 women of mean age 33 years; 25 completed six sessions. Women valued an established and trustful relationship with their VHW, which ensured confidentiality and prevented gossip, and reported finding individual problem-solving therapy beneficial. Peer-support meetings provided space to share problems, solutions and skills. The proportion of women with depression or suicidal ideation on the EPDS declined from 68% to 12% [difference 56% (95% confidence interval (CI) 27.0–85.0); p = 0.001], and the proportion scoring high (>7) on the SSQ declined from 52% to 4% [difference 48% (95% CI 24.4–71.6); p < 0.001] after the 6-week intervention. Conclusion VHW-delivered problem-solving therapy and peer-support was acceptable and showed promising results in this pilot evaluation, leading to quantitative and qualitative improvements in mental health among rural Zimbabwean women. Scale-up of the Friendship Bench in rural areas would help close the treatment gap for common mental disorders.

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Prevalence and Correlates of Posttraumatic Stress Disorder and Common Mental Disorders in Lay Health Workers Working on the Friendship Bench Program in Zimbabwe

SSRN Electronic Journal ◽

10.2139/ssrn.3436300 ◽

2019 ◽

Author(s):

Ruth Verhey ◽

Jonathan Brakarsh ◽

Lorna Gibson ◽

Dixon Chibanda ◽

Soraya Seedat

Keyword(s):

Posttraumatic Stress Disorder ◽

Mental Disorders ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Health Workers ◽

Common Mental Disorders ◽

Lay Health Workers

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The experiences of lay health workers trained in task-shifting psychological interventions: a qualitative systematic review

International Journal of Mental Health Systems ◽

10.1186/s13033-019-0320-9 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 4

Author(s):

Ujala Shahmalak ◽

Amy Blakemore ◽

Mohammad W. Waheed ◽

Waquas Waheed

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Health Workers ◽

Common Mental Disorders ◽

Task Shifting ◽

Alternative Methods ◽

Psychological Interventions ◽

Lay Health Workers ◽

The Impact ◽

Therapy Delivery

Abstract Introduction The prevalence of common mental disorders, such as depression and anxiety, is high and the demand for psychological interventions and talking therapies is increasing. In order to meet this need, it is necessary to explore alternative methods to deliver talking therapies. Training lay health workers (LHWs) to deliver psychological interventions might be one possible solution to address current gaps in service provision. A number of studies have successfully used this approach to deliver psychological interventions in order to meet the demand for mental health care. Despite increased interest in this area, the evidence has not been synthesised or systematically reviewed. Methods Electronic databases (MEDLINE, EMBBASE, PsycINFO and CINHAL) were systematically searched to specifically capture studies on task-shifting psychological interventions for common mental disorders. Data were extracted on the experiences of the lay-workers on training and therapy delivery. Thematic analysis was used to analyse the data. Themes and subthemes of LHWs views on receiving training, barriers and facilitators to therapy delivery, factors required to become a successful therapist and the impact of training and therapy delivery on the therapists are described. Results 10 studies were eligible for inclusion. Key messages were: LHWs were satisfied with training but wanted more robust supervision; not enough time was given to training on understanding mental health problems; LHWs grew in confidence and this impacted on their personal relationships with others. Conclusion This is the first review to explore LHWs experiences in training and therapy delivery by synthesising existing qualitative research. A number of key messages derived out of this review can help in further improving the quality of the training programmes and highlighting the benefits that are available for the LHW in delivering psychological interventions.

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