Scaling up community-delivered mental health support and care: A landscape analysis

Abstract

IntroductionThe mental health crisis has caused widespread suffering and has been further exacerbated by the COVID-19 pandemic. Marginalized groups are especially affected, with many concerns rooted in social determinants of mental health. To stem this tide of suffering, consideration of approaches outside the traditional biomedical model will be necessary. Drawing from task-sharing models of mental health care that have been pioneered in low-resource settings, community-initiated care (CIC) represents a potentially promising collection of approaches. This landscape analysis seeks to identify examples of CIC that have been implemented outside of the research context, with the aim of identifying barriers and facilitators of scale up.MethodsA narrative review approach was used for this landscape analysis in which the PubMed database was searched and further supplemented with Google Scholar. Promising programs were then discussed over multiple rounds of meetings with the research team, consisting of collaborators with varied experiences in mental health. Using the selection criteria and feedback derived from group meetings, a final list of programs was identified and summarized according to common characteristics and features.ResultsThe initial PubMed search yielded 16 results, supplemented by review of the first 100 entries in Google Scholar. Through 5 follow-up meetings among team members, consensus was reached on a final list of 9 programs, which were grouped into three categories based on similar themes and topics: (1) approaches for the delivery of psychosocial interventions; (2) public health and integrative approaches to mental health; and (3) approaches for addressing youth mental health. Key facilitators to scale up included the importance of sustainable financing and human resources, addressing social determinants and stigma, engaging diverse stakeholders, leveraging existing health infrastructure, using sustainable training models, ensuring cultural relevance and appropriateness, and leveraging digital technologies.DiscussionThis landscape analysis, though not an exhaustive summary of the literature, describes promising examples of efforts to scale up CIC outside of the research context. Going forward, it will be necessary to mobilize stakeholders at the community, health system, and government levels to effectively promote CIC.

A microcosting approach for planning and implementing community-based mental health prevention programs: what does it cost?

“…The communities in the zip codes included have experienced the cumulative impact of multiple environmental disasters in the last decade [ 47 ]. Through a community-based process, the HMHC team identified the need for a broader focus on resiliency across multiple catastrophic events rather than a narrower focus on suicide, as initially intended [ 35 , 45 , 47 ]. In a microcosting study of intervention development, Lairson and colleagues found personnel contributing 69% of the cost [ 48 ].…”

Evaluating workforce needs: an investigation of healthcare professionals’ attitudes, beliefs and preparedness towards the management of Para athlete mental health at the Tokyo 2020 and Beijing 2022 Paralympic Games

“…The broader social and environmental context of the athlete’s personal factors such as age, gender, socioeconomic status and the athlete’s impairment played a role in mental health 4–6 50. Furthermore, many HCPs acknowledged it was likely that athletes in their country sought care from religious, spiritual or cultural healers and experienced language barriers during healthcare 51 52. These contextual influences need to be investigated further within developing countries, where healthcare is not as aligned to the western biomedical system 32 33 40 43.…”

Characteristics of undergraduate and second speciality mental health programmes in Peru: a cross-sectional study

“…Its approach is community-based and allows for collaboration between health professionals and non-specialists increasing the availability of staff. However, its effectiveness depends on funding, ongoing training and the active participation of community leaders and other stakeholders [ 50 ].…”