Supporting and Sustaining Nonspecialists to Deliver Mental Health Interventions in Low- and Middle-Income Countries : An Umbrella Review

This umbrella review used a systematic approach to examine the state of the evidence regarding the nonspecialist health worker (NSHW) workforce in mental health and psychosocial services in low- and middle-income countries (LMICs). Seventeen review articles were included in this analysis. Most reviews defined nonspecialists by their lack of formal mental health experience. Less than half of the reviews reported their qualifications and roles. Findings indicated that NSHWs were trained and supervised in a range of skills with variability in approaches, duration, format and topical focus. The evidence supporting NSHW-delivered interventions was mixed but mainly favourable, particularly for depression, anxiety and posttraumatic stress disorder; additionally, studies identified implementation challenges with the nonspecialist workforce. In conclusion, NSHWs are widely used in LMICs to address mental health needs and some indicators suggest the interventions they deliver are beneficial, yet little is known about their needs and requirements. Further work is needed to prioritise nonspecialists as a critical workforce in global mental health. This includes developing best practice models, new policies and investments and conducting further research.

Key implications for practice

• Though nonspecialist health workers (NSHWs) are used widely in low- and middle-income countries (LMICs) for mental health and psychosocial service delivery, there are major gaps in knowledge about the nonspecialist workforce including roles, definitions, training and supervision approaches and compensation.

• Additional investments are needed to strengthen mental health systems in LMICs, with policies that clearly identify the roles and responsibilities of NSHWs and fair compensation within the broader mental health service delivery system.

• Future research is needed that focuses on understanding the varying needs and requirements of NSHW in LMICs and developing best practice approaches that provide adequate support that can sustain nonspecialists in the long-term.