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Ensuring Quality in Psychological Support (WHO EQUIP): developing a competent global workforce
Open accessAbstract
Globally, the vast majority of people with mental health conditions do not receive effective care. Among people living with depression, only 1 in 5 persons in high-income countries and 1 in 27 in lower-middle income countries receive minimally adequate treatment1. There is a dearth of health workers trained in mental health care, with only one trained provider per 10,000 people in most countries2. One key action to improve access to mental health care is to expand psychological and psychosocial support services delivered by diverse cadres across settings3. There is now good evidence that persons who are not specialists in mental health can effectively deliver psychological interventions, but they must be adequately trained and supervised4. Non-specialist providers include primary care workers, community workers, psychosocial workers, teachers, family members and peers. However, unlike licensed professionals for whom there are professional associations to assure standards, there are usually no systems or mechanisms in place that check whether non-specialist providers have sufficient training and supervision to achieve minimum competency to effectively and safely deliver interventions. This raises the question: how can governments and the general population be assured that non-specialists provide quality care? One way to address this challenge is to establish competency-based training approaches and competency assessment measures that governments, non-governmental organizations and other institutions can use to benchmark skills for safe and effective care. Competency measures can be used to determine who is or is not competent as well as to tailor supervision and supplementary training to address gaps in skills. Having competency targets in mind can also inform training duration and content that may need to vary across sites or cadres. Competency-based training approaches have already demonstrated success in diverse areas of health care in low resource settings, including surgery and obstetric care5, 6. To facilitate competency-based training in psychosocial support, psychological treatments, and foundational helping skills, the World Health Organization (WHO) is developing the Ensuring Quality in Psychological Support (EQUIP) platform (https://www.who.int/mental_health/emergencies/equip/en/). The EQUIP platform aligns with WHO's work on universal health coverage, that is establishing competency frameworks across fields of health care. EQUIP will be an online resource to help program managers and trainers utilize competency assessments to evaluate trainings and to feedback those competency results to support trainee development and modify curricula. The full suite will comprise tutorials on implementing competency assessments, including how to achieve interrater reliability with global rating standards and how to use role plays to assess competency. It will include guidance for trainers on delivering competency-based training programs, and for implementation and adaptation of psychological interventions. In addition, the EQUIP platform will offer training modules on common factors that can be selected based on competency assessment outcomes. Common factors are general elements of psychosocial support and psychological care – such as communication skills, empathy, collaboration, and helper-client alliance – that are vital ingredients for any intervention to be effective7. Contents of the EQUIP platform have been informed by a theory of change workshop attended by mental health and psychosocial service stakeholders with different practice experiences from diverse global settings. The EQUIP team has reviewed manuals and training materials for interventions delivered by non-specialists with effectiveness demonstrated in randomized controlled trials. This has led to the identification of competencies for both common factors and specific classes of psychological interventions (e.g., cognitive, interpersonal, problem solving, behavioral and trauma-focused techniques). EQUIP will encompass a competency evaluation tool, the Enhancing Assessment of Common Therapeutic Factors (ENACT), that has been developed for role-play based assessment of mental health and psychosocial support skills for non-specialist and specialist providers across cultures, context and types of interventions8, 9. In addition, a suite of competency assessment tools based on ENACT is being developed and tested. Below we briefly outline who, how, where and when EQUIP can be used. Who can use EQUIP? EQUIP is intended for trainers, supervisors and project managers implementing psychosocial support and psychological interventions. How can EQUIP be used? EQUIP can be used to improve implementation plans, competency assessments of trainees, and training and supervision curricula in common factors to accompany manualized interventions. Competency assessments may also be used to aid selection of trainees and to guide institutional certification after achiev
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
The World Health Organization is developing EQUIP, an online/offline platform to support competency-based training and assessment for psychological and psychosocial support delivered by diverse cadres. EQUIP aims to help trainers, supervisors, and project managers assure minimum competency, including through tools such as ENACT, and will be piloted before materials are available in English, Arabic, and Spanish.
Key findings
- Most people with mental health conditions do not receive effective care: among people with depression, only 1 in 5 in high-income countries and 1 in 27 in lower-middle income countries receive minimally adequate treatment, and most countries have only one trained provider per 10,000 people.
- Non-specialists can effectively deliver psychological interventions if adequately trained and supervised, but unlike licensed professionals, there are usually no systems to check whether they achieve minimum competency for safe and effective care.
- WHO is developing EQUIP to provide competency-based training and assessment resources, including tutorials, guidance on role-play assessment and interrater reliability, common-factors training modules, and the ENACT competency evaluation tool.
- EQUIP is intended for trainers, supervisors, and project managers; it will be an online platform with offline formats, developed using human-centered design, piloted in multiple countries, and after piloting made available in English, Arabic, and Spanish.
Methods
- This is a program description/letter, not an empirical study; it outlines the rationale, development, intended users, and planned contents of the WHO EQUIP platform.
- EQUIP contents were informed by a theory of change workshop with mental health and psychosocial service stakeholders from diverse global settings, and by review of manuals and training materials for non-specialist-delivered interventions with effectiveness demonstrated in randomized controlled trials.
- The paper reports no sample size, outcome data, or statistical analysis; it states that EQUIP is being developed using a human-centered design approach and piloted in multiple countries.
Limitations
- The paper states no formal limitations.
- Evident from the text: EQUIP is still being developed and piloted, so no empirical results on usability, competency assessment reliability/validity, implementation, or impact on care quality are reported.
- The text provides no data on whether competency-based training or EQUIP tools improve provider skills or patient outcomes.
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0 of 9 cited sources checked · 0 supported · 0 flagged
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In the paper
“The EQUIP team has reviewed manuals and training materials for interventions delivered by non-specialists with effectiveness demonstrated in randomized controlled trials.This has led to the identification of competencies for both common factors and specific classes of psychological interventions (e.g., cognitive, interpersonal, problem solving, behavioral and trauma-focused techniques).”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Competency-based training approaches have already demonstrated success in diverse areas of health care in low resource settings, including surgery and obstetric care 5,6 .”
Strength:boosted· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“EQUIP will encompass a competency evaluation tool, the Enhancing Assessment of Common Therapeutic Factors (ENACT), that has been developed for role-play based assessment of mental health and psychosocial support skills for non-specialist and specialist providers across cultures, context and types of interventions 8,9 .”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“One key action to improve access to mental health care is to expand psychological and psychosocial support services delivered by diverse cadres across settings 3 .”
What the sources say
- Not checked yetcites [3] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“There is now good evidence that persons who are not specialists in mental health can effectively deliver psychological interventions, but they must be adequately trained and supervised 4 .”
What the sources say
- Not checked yetcites [4] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“Common factors are general elements of psychosocial support and psychological care -such as communication skills, empathy, collaboration, and helper-client alliance -that are vital ingredients for any intervention to be effective 7 .”
What the sources say
- Not checked yetcites [7] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“There is a dearth of health workers trained in mental health care, with only one trained provider per 10,000 people in most countries 2 .”
What the sources say
- Not checked yetcites [2]
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- Probably not a substantial claim. 1
- It may state two separate claims as one. 2
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“To refine the platform and its materials, EQUIP is being developed using a human-centered design approach to enhance usability and engagement, and piloted in multiple countries.”
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Among people living with depression, only 1 in 5 persons in high-income countries and 1 in 27 in lower-middle income countries receive minimally adequate treatment 1 .”
What the sources say
- Not checked yetcites [1] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
In most settings, no established systems verify that non-specialist providers have enough training and supervision to reach the minimum competence needed for safe and effective delivery of interventions.
“However, unlike licensed professionals for whom there are professional associations to assure standards, there are usually no systems or mechanisms in place that check whether non-specialist providers have sufficient training and supervision to achieve minimum competency to effectively and safely deliver interventions.”
The paper relies on this without support.
Meeting mental health and psychosocial needs demands a major expansion of the global workforce so that psychosocial support and evidence-based psychological interventions can be delivered safely and effectively.
“Addressing mental health and psychosocial needs requires radical growth in the global workforce to ensure safe and effective delivery of psychosocial support and evidence-based psychological interventions.”
The paper relies on this without support.
Competency assessments can identify who is competent and can guide supervision and additional training to fill skill gaps.
“Competency measures can be used to determine who is or is not competent as well as to tailor supervision and supplementary training to address gaps in skills.”
The paper relies on this without support.
Setting competency targets can help determine how long training should last and what it should cover, which may differ by location or worker group.
“Having competency targets in mind can also inform training duration and content that may need to vary across sites or cadres.”
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Each is checked against this paper’s own text: does it say what the citing paper says it does?
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In the citing paper
“and recent initiatives such as the WHO’s EQUIP: Ensuring Quality in Psychosocial Support, which seeks to develop and compile comprehensive sets of quality resources for psychological and psychosocial support interventions globally [87, 88].”
Citations
Cites
How important are the common factors in psychotherapy? An update
Wampold, B. E. (2015) · World Psychiatry · doi:10.1002/wps.20238 · Cited by 1,728
Undertreatment of people with major depressive disorder in 21 countries
Thornicroft, G., Chatterji, S., Evans-Lacko, S., Gruber, M., Sampson, N., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L., Borges, G., et al. (2017) · British Journal of Psychiatry · doi:10.1192/bjp.bp.116.188078 · Cited by 1,121
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Self-citationThe global dissemination of psychological treatments: A road map for research and practice
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Self-citationScaling up psychological treatments for common mental disorders: a call to action
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Research works printed but not linked: 1
- World Health Organization, 2018, Mental health atlas 2017
Cited by
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Pedersen, G. A., Shrestha, P., Akellot, J., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.43.pr11
Pedersen, G. A., Shrestha, P., Akellot, J., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.43.pr3
Pedersen, G. A., Shrestha, P., Akellot, J., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.43.pr10
Pedersen, G. A., Shrestha, P., Akellot, J., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.43.pr4
Pedersen, G. A., Shrestha, P., Akellot, J., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.43.pr6
Pedersen, G. A., Shrestha, P., Akellot, J., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.43.pr5
Pedersen, G. A. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.43.pr1
Self-citationPedersen, G. A. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.43.pr7
Self-citationPedersen, G. A., Shrestha, P., Akellot, J., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.43.pr2
Pedersen, G. A., Shrestha, P., Akellot, J., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.43.pr8
Pedersen, G. A., Shrestha, P., Akellot, J., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.43.pr9
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Mbwayo, A. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.35.pr4
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Mbwayo, A. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.35.pr1
Advances and New Perspectives in Higher Education Quality
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Cid‐Vega, A., Han, L., & Brown, A. D. (2025) · Springer eBooks · doi:10.1007/978-3-032-06243-7_15
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Self-citationSpaaij, J., Fuhr, D. C., Akhtar, A., Casanova, L., Klein, T., Schick, M., Weilenmann, S., Roberts, B., & Morina, N. (2023) · Figshare · doi:10.6084/m9.figshare.22826932
Spaaij, J., Fuhr, D. C., Akhtar, A., Casanova, L., Klein, T., Schick, M., Weilenmann, S., Roberts, B., & Morina, N. (2023) · Figshare · doi:10.6084/m9.figshare.22826929
Lufumpa, N., Hilger, A., Shaw, A., Rudiman, G., Moscoe, E., Experton, L., Kohrt, B. A., Ng, O., & Wahid, S. S. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100577 · Cited by 1
Self-citationRose, A. L., Jack, H. E., Aaron, L., Jacobs, Y., Ciya, N., Ndamase, S., Johnson, K., Regenauer, K. S., Kagee, A., Kohrt, B. A., et al. (2026) · SSM - Mental Health · doi:10.1016/j.ssmmh.2026.100655
Self-citationWong, J., Xu, T., Perez, K. G., Khadduri, A., Scott, Y., Watkins, F., Oswiecimski, J., Wang, A., Antonaki, E., Slachevsky, D. E., et al. (2026) · Pilot and Feasibility Studies · doi:10.1186/s40814-026-01840-8
Self-citationAram, T., Silvela, L., & Ventevogel, P. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1824107
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Metadata
- Authors
- Kohrt, B. A., Schafer, A., Willhoite, A., van't Hof, E., Pedersen, G. A., Watts, S., Ottman, K., Carswell, K., & van Ommeren, M.
- Affiliations
- George Washington University (US)
- World Health Organization (CH)
- United States Agency for International Development (US)
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- ORCID
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2020-01-10
- Volume
- 19
- Issue
- 1
- Pages
- 115-116
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC6953555
- OpenAlex
- W2999310245
- Semantic Scholar
- 3df85165a4ba3642353d9ed0440d5a806d7090f0
- Cited by
- 130
- References
- 8
- Citations by year
- 2026: 7 · 2025: 16 · 2024: 19 · 2023: 48 · 2022: 19 · 2021: 14 · 2020: 6
- FWCI
- 16.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- United States Agency for International Development
- World Health Organization
- Topics
- Social Sciences › Education › Innovations in Medical Education
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Competency Development and Evaluation
- Keywords
- mental health professionals, competency-based training, competency assessment, psychosocial support, psychological intervention, inter-rater reliability, role-play assessment, training supervision, access to mental health care, resource-limited settings, curriculum adaptation, universal health coverage, peer support, community workers, primary care providers, teacher mental health
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