Non-specialist health workers play important role in improving mental health in developing countries
New research shows benefits for people with depression, anxiety, dementia, maternal depression, post traumatic stress disorder and alcohol abuse.
Non-specialist health workers are beneficial in providing treatment for people with mental, neurological and substance-abuse (MNS) problems in developing countries – where there is often a lack of mental health professionals – according to a new Cochrane review.
Researchers, led by the London School of Hygiene & Tropical Medicine, say non-specialist health workers (such as doctors, nurses or lay health workers) not formally trained in mental health or neurology, and other professionals with health roles, such as teachers, may have an important role to play in delivering MNS health care. The study is the first systematic review of non-specialist health workers providing MNS care in low- and middle-income countries.
After examining 38 relevant studies from 22 developing countries*, researchers found that non-specialist health workers were able to alleviate some depression or anxiety. For patients with dementia, non-specialists seemed to help in reducing symptoms and in improving their carers’ coping skills. Non-specialists may also have benefits in treating maternal depression, post traumatic stress disorder as well as alcohol abuse, though the improvements may be smaller.
Lead author Dr Nadja van Ginneken, who completed the research at the London School of Hygiene & Tropical Medicine’s Centre for Global Mental Health with funding from the Wellcome Trust Clinical PhD programme, said: “Many low- and middle-income countries have started to train primary care staff, and in particular lay and other community-based health workers, to deliver mental health care. This review shows that, for some mental health problems, the use of non-specialist health workers has some benefits compared to usual care.”
Vikram Patel, Professor of International Mental Health at the London School of Hygiene & Tropical Medicine, said: "This review’s primary message is that non-specialist health workers have an important role to play in delivering interventions for a range of mental disorders and can thereby play a key role in addressing the human resource shortages in mental health care in low- and middle-income countries.”
While the research showed promise in using non-specialist health workers to improve mental health outcomes in developing countries, the authors note that more evidence is needed in this area as many studies were of low quality. More evidence is also needed on non-specialists’ effectiveness when treating epilepsy, severe mental disorders such as schizophrenia, and child mental disorders. The researchers add that there were also too few studies to draw conclusions about the cost-effectiveness of using non-specialist health workers or teachers.
Nadja van Ginneken, Prathap Tharyan, Simon Lewin, Girish N Rao, SM Meera, Jessica Pian, Sudha Chandrashekar, Vikram Patel. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database of Systematic Reviews 2013. DOI: 10.1002/14651858.CD009149.pub2
* Of the 38 included studies, 15 studies were conducted in low-income countries: Burundi (one study), Kenya (two studies), Nepal (one study), Pakistan (three studies), Rwanda (two studies), Sri Lanka (two studies) and Uganda (four studies). 23 studies were from middle-income countries: Argentina (one study), Bosnia (one study), Chile (three studies), China (three studies), Hungary (one study), India (two studies), Indonesia (two studies), Jamaica (one study), Kosovo (one study), Malaysia (one study), Palestinian Territories (two studies), Russia (one study), Thailand (two studies), Turkey (one study) and Vietnam (one study).
Image: Mental health protest march. Credit: Centre for Global Mental Health