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

2019 ◽  
Vol 13 (1) ◽  
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.

Task-shifting in Mental Health Services: Extent, Impact and Challenges in Ghana

2017 ◽  
Vol 41 (S1) ◽  
pp. S618-S618
Author(s):  
V. Agyapong
Keyword(s):  
Mental Health ◽  
Health Policy ◽  
Health Workers ◽  
Continuing Professional Development ◽  
Task Shifting ◽  
Mental Health Workers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
The Impact

AimTo examine the role and scope of practice of community mental health workers (CMHWs) as well as the impact and challenges associated with of work of CMHWs within Ghana's mental health delivery system.MethodsA cross sectional survey of 11 psychiatrists, 29 health policy directors and 164 CMHWs as well as key informant interviews with 3 CMHWs, 5 psychiatrists and 2 health policy directors and three focus group discussions with 21 CMHWs. Results of quantitative data were analysed with SPSS version 20 whilst the results from qualitative data were analysed manually through thematic analysis.ResultsIn addition to duties prescribed in their job descriptions, all the CMHWs identified several jobs that they routinely perform including jobs reserved for higher level cadres such as medication prescribing for which most of the CMHWs have no training. Some CMHWs reported they had considered leaving the mental health profession because of the stigma, risk, lack of opportunities for continuing professional development and career progression as well as poor remuneration. Almost all the stakeholders believed CMHWs in Ghana receive adequate training for the role they are expected to play although many identify some gaps in the training of these mental health workers for the expanded roles they actually play. All the stakeholders expressed concerns about the quality of the care provided by CMHWs.ConclusionThe study highlights several important issues, which facilitate or hinder effective task-shifting arrangements from psychiatrists to CMHWs and impact on the quality of care provided by the latter.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals Living under siege: resilience, hopelessness, and psychological distress among Palestinian students in the Gaza Strip

2021 ◽  
Vol 8 ◽  
Author(s):  
Guido Veronese ◽  
Alessandro Pepe ◽  
Marwan Diab ◽  
Yasser Abu Jamey ◽  
Ashraf Kagee
Keyword(s):  
Mental Health ◽  
Human Rights ◽  
Psychological Distress ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Gaza Strip ◽  
Mental Symptoms ◽  
The Gaza Strip ◽  
Anxiety Depression ◽  
The Impact

Abstract Background Moving from an approach oriented to adaptation and functioning, the current paper explored the network of cumulative associations between the effects of the siege and resilience on mental health. Methods We sought to explore the impact of the siege on psychological distress (anxiety, depression, and stress) and the moderating effect of resilience and hopelessness in a sample of 550 Palestinian university students. We hypothesized that the siege effect would impact psychological distress so that the more people were affected by the siege, the more mental symptoms of common mental disorders they would report. We also expected that the siege would negatively impact both resilience and participants' hopelessness. Results Findings showed that higher scores on the scale measuring effect of the siege were associated with hopelessness. Furthermore, living under siege compromised participants’ resilience. The more the siege affected individuals, the lower resilience were protecting participants mental health and the more hopelessness was exposing them to anxiety, stress, and depression. Conclusion Our findings draw attention to how the ongoing violation of human rights influences people's mental health in Gaza. Implications for clinicians and policymakers are discussed.

scholarly journals Lessons from a theory of change-driven evaluation of a global mental health funding portfolio

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
G. Miguel Esponda ◽  
G. K. Ryan ◽  
G. Lockwood Estrin ◽  
S. Usmani ◽  
L. Lee ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Workers ◽  
Common Mental Disorders ◽  
Global Mental Health ◽  
Descriptive Analysis ◽  
Theory Of Change ◽  
Mental Health Funding ◽  
Health Funding ◽  
High Staff Turnover ◽  
The Impact

Abstract Background Given the underinvestment in global mental health to-date, it is important to consider how best to maximize the impact of existing investments. Theory of Change (ToC) is increasingly attracting the interest of funders seeking to evaluate their own impact. This is one of four papers investigating Grand Challenges Canada’s (GCC’s) first global mental health research funding portfolio (2012–2016) using a ToC-driven approach. Methods A portfolio-level ToC map was developed through a collaborative process involving GCC grantees and other key stakeholders. Proposed ToC indicators were harmonised with GCC’s pre-existing Results-based Management and Accountability Framework to produce a “Core Metrics Framework” of 23 indicators linked to 17 outcomes of the ToC map. For each indicator relevant to their project, the grantee was asked to set a target prior to the start of implementation, then report results at six-month intervals. We used the latest available dataset from all 56 projects in GCC’s global mental health funding portfolio to produce a descriptive analysis of projects’ characteristics and outcomes related to delivery. Results 12,999 people were trained to provide services, the majority of whom were lay or other non-specialist health workers. Most projects exceeded their training targets for capacity-building, except for those training lay health workers. Of the 321,933 people screened by GCC-funded projects, 162,915 received treatment. Most projects focused on more than one disorder and exceeded all their targets for screening, diagnosis and treatment. Fewer people than intended were screened for common mental disorders and epilepsy (60% and 54%, respectively), but many more were diagnosed and treated than originally proposed (148% and 174%, respectively). In contrast, the three projects that focused on perinatal depression exceeded screening and diagnosis targets, but only treated 43% of their intended target. Conclusions Under- or over-achievement of targets may reflect operational challenges such as high staff turnover, or challenges in setting appropriate targets, for example due to insufficient epidemiological evidence. Differences in delivery outcomes when disaggregated by disorder suggest that these challenges are not universal. We caution implementers, funders and evaluators from taking a one-size-fits all approach and make several recommendations for how to facilitate more in-depth, multi-method evaluation of impact using portfolio-level ToC.

scholarly journals Lessons From a Theory of Change-driven Evaluation of a Global Mental Health Funding Portfolio

2020 ◽  
Author(s):  
Georgina Miguel-Esponda ◽  
Grace Kathryn Ryan ◽  
Georgia Lockwood-Estrin ◽  
Shamaila Usmani ◽  
Lucy Lee ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Workers ◽  
Common Mental Disorders ◽  
Global Mental Health ◽  
Descriptive Analysis ◽  
Theory Of Change ◽  
Mental Health Funding ◽  
Health Funding ◽  
High Staff Turnover ◽  
The Impact

Abstract BackgroundGiven the underinvestment in global mental health to-date, it is important to consider how best to maximize the impact of existing investments. Theory of Change (ToC) is increasingly attracting the interest of funders seeking to evaluate their own impact. This is the first of four papers investigating Grand Challenges Canada’s (GCC’s) first global mental health research funding portfolio (2012-2016) using a ToC-driven approach.MethodsA portfolio-level ToC map was developed through a collaborative process involving GCC grantees and other key stakeholders. Proposed ToC indicators were harmonised with GCC’s pre-existing Results-based Management and Accountability Framework to produce a “Core Metrics Framework” of 23 indicators linked to 17 outcomes of the ToC map. For each indicator relevant to their project, the grantee was asked to set a target prior to the start of implementation, then report results at six-month intervals. We used the latest available dataset from all 56 projects in GCC’s global mental health funding portfolio to produce a descriptive analysis of projects’ characteristics and outcomes related to delivery. Results12,999 people were trained to provide services, the majority of whom were lay or other non-specialist health workers. Most projects exceeded their training targets for capacity-building, except for those training lay health workers. Of the 321,933 people screened by GCC-funded projects, 162,915 received treatment. Most projects focused on more than one disorder and exceeded all their targets for screening, diagnosis and treatment. Fewer people than intended were screened for common mental disorders and epilepsy (60% and 54%, respectively), but many more were diagnosed and treated than originally proposed (148% and 174%, respectively). In contrast, the three projects that focused on perinatal depression exceeded screening and diagnosis targets, but only treated 43% of their intended target. ConclusionsUnder- or over-achievement of targets may reflect operational challenges such as high staff turnover, or challenges in setting appropriate targets, for example due to insufficient epidemiological evidence. Differences in delivery outcomes when disaggregated by disorder suggest that these challenges are not universal. We caution implementers, funders and evaluators from taking a one-size-fits all approach and make several recommendations for how to facilitate more in-depth, multi-method evaluation of impact using portfolio-level ToC.

scholarly journals O5C.3 The mental health impact of deployment to iraq and afghanistan: what does the current data show?

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A46.1-A46
Author(s):  
Sharon Stevelink ◽  
Margaret Jones ◽  
Lisa Hull ◽  
David Pernet ◽  
Shirlee MacCrimmon ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Health Outcomes ◽  
Alcohol Misuse ◽  
Common Mental Disorders ◽  
Health Impact ◽  
Current Data ◽  
Mental Health Outcomes ◽  
The Uk ◽  
The Impact

The longer term mental health outcomes of UK serving and ex-serving personnel have been the subject of much speculation. The latest research findings from the third phase of a longitudinal study will be presented, which is the only military cohort study of its kind in the UK. Data was collected among 8093 personnel between 2014 and 2016. The study examined the prevalence of mental disorders and alcohol misuse, whether rates differed between serving and ex-serving regular personnel and the impact of various deployment exposures. The prevalence of probable posttraumatic stress disorder was 6.2% (95% confidence interval (CI) 5.5–6.9), 21.9% (95% CI 20.8–23.0) for common mental disorders and 10.0% (95% CI 9.2–10.9) for alcohol misuse. Deployment to Iraq or Afghanistan and self-reported role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel. There was no association with number of deployments for any outcome. The findings highlight the importance of the continued monitoring of following personnel throughout their military career and beyond. The implications of the study outcomes will be discussed in the light of the mental health provision for serving and ex-serving personnel.

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