Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence

Abstract

Objective.This paper seeks to review the available evidence to determine whether a systems approach is employed in the implementation and evaluation of task shifting for mental health using lay providers in low- and middle-income countries, and to highlight system-wide effects of task-shifting strategies in order to better inform efforts to strength community mental health systems.Methods.Pubmed, CINAHL, and Cochrane Library databases were searched. Articles were screened by two independent reviewers with a third reviewer resolving discrepancies. Two stages of screens were done to ensure sensitivity. Studies were analysed using the World Health Organization's building blocks framework with the addition of a community building block, and systems thinking characteristics to determine the extent to which system-wide effects had been considered.Results.Thirty studies were included. Almost all studies displayed positive findings on mental health using task shifting. One study showed no effect. No studies explicitly employed systems thinking tools, but some demonstrated systems thinking characteristics, such as exploring various stakeholder perspectives, capturing unintended consequences, and looking across sectors for system-wide impact. Twenty-five of the 30 studies captured elements other than the most directly relevant building blocks of service delivery and health workforce.Conclusions.There is a lack of systematic approaches to exploring complexity in the evaluation of task-shifting interventions. Systems thinking tools should support evidence-informed decision making for a more complete understanding of community-based systems strengthening interventions for mental health.

Healthcare professionals’ perspectives on mental health service provision: a pilot focus group study in six European countries

“…These inequities in accessibility are discussed in the literature and HPs are mindful of them [36]. The HPs concurred with the literature that increases in funding and human resources, along with the application of mobile mental health services, electronic health records, screening tools, and the application of electronic mental healthcare (e-MHC) are seen as positive developments [12] that can diminish the financial problems and inequity in accessibility.…”

“…Indeed, MH challenges emanate from a multitude of factors, including other health problems and contextual and sociocultural factors, all of which interact in a dynamic fashion [12]. This complexity and the concomitant ambivalence in defining mental health concerns are barriers to providing optimal care and create the need for continuous training, systemic evaluations of MH needs and flexibility in care provision since diagnosis alone can easily lead to labeling and stigmatization [54].…”

“…In a study that focused on such MHC arrangements, Beckers et al [8] report that such needs can be effectively served in primary care when professionals are mindful of personal recovery goals, use social supports and have adequate training. Patel and Chatterji [11] and Javadi et al [12] recommended comprehensive training, teamwork, and task shifting to increase the capacities of HPs working in primary care as ways to enhance and augment the effectiveness of person-centered care.…”

The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness

“…Rigorous implementation research on task shared CC models is underway and the outcome of this research will hopefully improve our understanding of the quality, safety, effectiveness and acceptability of strategies for mental health problems in LMICs. [324][325][326] Case studies from non-governmental organisations indicate that inefficient health system structures can present barriers to successful task-sharing; indicating a need for more CC services. 324 However, whether such approaches will be successful in reducing premature mortality, improving wellbeing and achieving better social outcomes in LMIC settings has yet to be fully established.…”

Future Directions in Single-Session Youth Mental Health Interventions

“…This notion of task-sharing, or the practice of delegating specific mental health service delivery tasks to lay providers, is not new; this model has been tested as an acceptable means of helping to reduce treatment gap . Common barriers to task-sharing efforts include lay providers' feeling ill-equipped to deliver mental health interventions (Hung et al, 2014;Mendenhall et al, 2014) ongoing support and supervision (Javadi, Feldhaus, Mancuso, & Ghaffar, 2017). Fortunately, SSIs' structure alleviates several of these concerns: many SSIs require little to no training to administer, and several can be completed independently by youths in less than one hour.…”