Testing the Effectiveness of Implementing a Model of Mental Healthcare Involving Trained Lay Health Workers in Treating Major Mental Disorders Among Youth in a Conflict-Ridden, Low-Middle Income Environment: Part II Results

Abstract

Objectives: To report the outcomes of young people (aged 14-30 years) treated for major mental disorders in a lay health worker (LHW) intervention model in a rural district of conflict-ridden Kashmir, India. Methods: Over a 12-month follow-up, LHWs collected data on symptoms, functioning, quality of life and disability, and patients’ and families’ service engagement and satisfaction. Results: Forty trained LHWs (18 males and 22 females) identified 262 individuals who met the criteria for a diagnosis of a major mental disorder, connected them with specialists for treatment initiation (within 14 days), and provided follow-up and support to patients and families. Significantly more patients (14-30 years) were identified during the 14 months of the project than those in all age groups in the preceding 2 years. At 12 months, 205 patients (78%) remained engaged with the service and perceived it as very helpful. Repeated measures ANOVA showed significant improvements in scores on the global assessment of functioning (GAF) scale (F[df, 3.449] = 104.729, p < 0.001) and all 4 domains of the World Health Organization quality of life (WHOQOL) brief version (WHOQOL-BREF) of the survey—Physical F(df, 1.861) = 40.82; Psychological F(df, 1.845) = 55.490; Social F(df, 1.583) = 25.189; Environment F(df, 1.791) = 40.902, all ps < 0.001—and a decrease in disability (F[df, 1.806] = 4.364, p = 0.016). An interaction effect between time and sex was observed for the physical health domain of the WHOQOL-BREF. Discussion and Conclusions: Our results show that an LHW-based service model, implemented in a rural setting of a low-to-middle income region plagued by long-term conflict, benefits young people with major mental disorders. We discuss the implications of our findings in the context of similar environments and the challenges encountered.

Educational and Training Interventions Aimed at Healthcare Workers in the Detection and Management of People With Mental Health Conditions in South and South-East Asia: A Systematic Review

“…Twenty-three (59%) studies provided interventions that addressed common mental disorders (CMD) (24, 25, 29, 34-36, 38, 39, 41-43, 47-49, 52, 54, 55, 57, 67-71), five (13%) addressed severe mental illness (26,27,30,37,40), and 10 studies (26%) addressed both common and severe illnesses (28,31,33,44,45,49,50,53,56,58). Thirty-six studies (92%) provided training to participants face-to-face (24-28, 31, 33-58, 67-70) and eight (21%) used digital technology and web-based training (24, 28-30, 50, 67, 68, 71).…”

“…Training interventions were commonly delivered by multidisciplinary teams (n = 12, 31%) comprising of psychiatrists, psychologists, counsellors, and social workers (25,26,28,30,33,37,41,49,56,67,69,70). Six studies (15%) were delivered by a psychiatrist (27,32,34,40,50,53), two (5%) by a psychologist (36,71), and one (3%) by a social worker (35).…”

“…Twenty-three studies (59%) evaluated the knowledge, skills and attitude of healthcare workers (24, 25, 29-31, 33, 35-37, 41, 43, 45, 46, 49, 50, 53-58, 68, 69), 18 studies (46%) assessed diagnostic capabilities and competencies (26, 27, 29, 30, 33-35, 40-43, 45-47, 51, 54, 69, 71) three (8%) studies assessed referral ability (35,43,51), four (10%) measured stigma among healthcare workers (26,46,49,69) and three (8%) assessed patient's well-being status (43, 47, 51).…”

Community health workers: challenges and vulnerabilities of Accredited Social Health Activists working in conflict-affected settings in the state of Assam, India

“…We believe that the skill on psychological first aid will help ASHAs in coping with their stress, and anxiety as well as the community they are serving. Psychological first aid training was found to be an important skill during the Ebola crisis in Sierra Leone and had a positive impact [ 33 ]; closer to home, a study with lay health workers providing mental health counselling was found to have an impact, although the role of such training in the mental well-being of workers themselves was not explored [ 7 ]. Concurrently, we also believe that having access to psychosocial support services such as counselling during and after the conflict will help ASHAs to take responsibility for their lives and the community at large.…”

“…Conflict-affected health systems in countries like Afghanistan, Burkina Faso have also engaged CHWs to provide essential services under restrictive and sometimes dangerous situations [ 6 ]. In India, we found one study demonstrating the effectiveness of a lay health worker intervention in a rural conflict ridden district of Kashmir state [ 7 ], and another showing feasibility of community health worker supported tuberculosis patient tracing using GeneXpert in naxal conflict affected border areas of Chhattisgarh state [ 7 , 8 ]. However, in neither case were ASHA workers involved even as they are employed in all of the conflict -affected regions of india, which include the erstwhile state of Jammu and Kashmir as well as six of the eight states in the northeast region.…”