Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence
Open accessAbstract
Objective.: This paper seeks to review the available evidence to determine whether a systems approach is employed in the implementation and evaluation of task shifting for mental health using lay providers in low- and middle-income countries, and to highlight system-wide effects of task-shifting strategies in order to better inform efforts to strength community mental health systems. Methods.: Pubmed, CINAHL, and Cochrane Library databases were searched. Articles were screened by two independent reviewers with a third reviewer resolving discrepancies. Two stages of screens were done to ensure sensitivity. Studies were analysed using the World Health Organization's building blocks framework with the addition of a community building block, and systems thinking characteristics to determine the extent to which system-wide effects had been considered. Results.: Thirty studies were included. Almost all studies displayed positive findings on mental health using task shifting. One study showed no effect. No studies explicitly employed systems thinking tools, but some demonstrated systems thinking characteristics, such as exploring various stakeholder perspectives, capturing unintended consequences, and looking across sectors for system-wide impact. Twenty-five of the 30 studies captured elements other than the most directly relevant building blocks of service delivery and health workforce. Conclusions.: There is a lack of systematic approaches to exploring complexity in the evaluation of task-shifting interventions. Systems thinking tools should support evidence-informed decision making for a more complete understanding of community-based systems strengthening interventions for mental health.
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TL;DR
This review of 30 studies in LMICs found task shifting for mental health using lay providers was generally feasible and effective, but evaluations rarely applied systems thinking. No included study explicitly used systems thinking tools, though some captured system-wide elements across WHO health system building blocks.
Key findings
- Thirty studies were included; almost all showed positive mental health findings and one showed no effect. Task shifting was generally feasible and acceptable, but perceptions of quality of care provided by lay providers remained uncertain.
- Twenty-five of 30 studies (83%) mentioned at least one WHO building block beyond service delivery and health workforce; all 30 included the added community/people building block. Among the 25, 16 (80%) considered information/technology, 11 (55%) medicines/medical devices, 15 (70%) financing, and 10 (50%) leadership/governance.
- No studies explicitly employed systems thinking tools or system dynamics modelling, but six studies took a more comprehensive approach to capturing system implications, such as stakeholder perspectives, feedback, and intersectoral effects.
- Barriers included stigma, poor documentation/follow-up, medicine access and prescribing-training gaps, demand-side financial/geographic barriers, heavy workloads, weak collaboration with traditional/spiritual healers, and provider–decision-maker disconnect. Facilitators included lay providers’ community relatability, specialist support, technology/telemedicine supervision, integrated livelihood/social supports, and existing networks.
Methods
- Systematic review: PubMed, CINAHL, and Cochrane were searched 5 September–30 October 2016. From 1357 records, 249 duplicates were removed, 1108 titles/abstracts were screened, 147 met first-stage criteria, and 30 papers were included. Two independent reviewers screened, with a blinded third reviewer resolving discrepancies; inclusion required LMIC setting, mental health focus, task shifting to lay providers with fewer than 3 years of training, research article, English, and not a pilot.
- Data extraction and analysis used CASP tools for quality and coded studies against the six WHO building blocks plus a seventh community/people block, along with systems thinking characteristics such as stakeholder perspectives, network/process mapping, feedback mechanisms, and system dynamics. No meta-analysis was done because interventions were diverse, conducted at multiple scales, and included qualitative evaluations.
Limitations
- Stated: the wide variety of mental health interventions, populations, and outcome measures may make broader conclusions difficult to apply to unique mental health conditions; some studies may have considered system-wide effects but not reported them in final manuscripts.
- Stated/evident: the search was limited to January 1996–September 2016, English peer-reviewed research articles, and excluded pilot studies; no meta-analysis was performed.
- Evident: because no included study explicitly used systems thinking tools, conclusions about system-wide effects rely on implicit mentions; the review also highlighted interventions primarily in the health sector, with few cross-sector task-shifting examples.
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One included study showed no effect of task shifting on mental health.
“One study showed no effect.”
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No included studies explicitly employed systems thinking tools.
“No studies explicitly employed systems thinking tools”
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“Use of system dynamics theory, causal loop diagrams, and other system modelling techniques were also included in the extraction criteria, but none were found.”
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All included studies showed that task shifting for mental health was feasible and acceptable in the given contexts.
“All studies showed that task shifting for mental health was feasible and acceptable in the given contexts”
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Perceptions of the quality of care provided by lay providers remain uncertain.
“perceptions of quality of care provided by lay providers remain uncertain”
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Some included studies demonstrated systems thinking characteristics, such as exploring various stakeholder perspectives, capturing unintended consequences, and looking across sectors for system-wide impact.
“some demonstrated systems thinking characteristics, such as exploring various stakeholder perspectives, capturing unintended consequences, and looking across sectors for system-wide impact.”
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Twenty-five of the 30 included studies captured elements other than the most directly relevant building blocks of service delivery and health workforce.
“Twenty-five of the 30 studies captured elements other than the most directly relevant building blocks of service delivery and health workforce.”
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Almost all included studies displayed positive findings on mental health using task shifting.
“Almost all studies displayed positive findings on mental health using task shifting.”
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Perception surveys in Ghana directly involved policy directors, which provided an improved understanding of the gap between perceptions of lay provider programmes by policy directors and realities in the field.
“Perception surveys in Ghana directly involved policy directors, which provided an improved understanding of the gap between perceptions of lay provider programmes by policy directors and realities in the field (Agyapong et al. 2015a, b, 2016).”
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Lay providers, not trained in prescription of psychotropic medicines, found themselves prescribing them due to community needs.
“That is, lay providers, not trained in prescription of psychotropic medicines, found themselves prescribing them due to community needs (Agyapong et al. 2015a).”
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Of the 30 studies, 25 (83%) included mention of the six WHO health system building blocks other than service delivery and health workforce.
“Of the 30 studies, 25 (83%) included mention of the six WHO health system building blocks other than service delivery and health workforce (Table 6).”
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Thirteen included papers were qualitative evaluations using surveys, interviews, focus groups, action research, implementation research, or case study methodology.
“Thirteen papers were qualitative evaluations using surveys, interviews, focus groups, action research, implementation research, or case study methodology”
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Some studies mentioned demand-side financing as a barrier to improved mental health delivery, citing the ability to pay for basic mental health services from the patient's perspective.
“Some studies mentioned demand-side financing as a barrier to improved mental health delivery, citing the ability to pay for basic mental health services from the patient's perspective (Neuner et al. 2008; Nimgaonkar & Menon, 2015; Abas et al. 2016).”
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Discrepancies between training and service delivery in prescribing practices were a challenge in task shifting for mental health.
“The discrepancies between training and service delivery in prescribing practices were a challenge in task shifting for mental health (Agyapong et al. 2016).”
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Supporting patients through advice for socioeconomic well-being and links to income-generating projects was a means through which lay providers tried to address demand-side financial barriers.
“Supporting patients through advice for socioeconomic well-being and links to income-generating projects was a means through which lay providers tried to address demand-side financial barriers (Baker-Henningham et al. 2005; Petersen et al. 2011; Lorenzo et al. 2015).”
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Ten studies (50%) mentioned leadership and governance issues with reference to task shifting for mental health.
“Finally, 10 studies (50%) mentioned leadership and governance issues with reference to task shifting for mental health.”
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Eleven studies (55%) considered the implications of the medicines and medical devices.
“Eleven studies (55%) considered the implications of the medicines and medical devices.”
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Ensuring that referrals were made to services covered by social protection mechanisms was raised as an important element of providing sustainable and effective mental health service delivery by lay providers.
“Ensuring that referrals were made to services covered by social protection mechanisms, was raised as an important element of providing sustainable and effective mental health service delivery by lay providers (Lorenzo et al. 2015; Padilla et al. 2015).”
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Lack of financial incentives for lay providers and their supervisors was a challenge raised.
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The bias towards medication as treatment created challenges for prioritization of psychotherapy and behavioural interventions, affecting demand-side acceptability.
“The bias towards medication as treatment also created challenges for prioritization of psychotherapy and behavioural interventions, affecting demand-side acceptability (Mendenhall et al. 2014).”
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Twelve included papers were randomized controlled trials.
“Twelve papers were randomized controlled trials”
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All 30 studies included some aspect of the seventh additional building block (communities and people) through community engagement and/or efforts to understand community needs in order to best integrate lay providers.
“All 30 studies included some aspect of the seventh additional building block (communities and people) through community engagement and/or efforts to understand community needs in order to best integrate lay providers.”
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Sixteen studies of the 25 (80%) considered the role of information and technology.
“Sixteen studies of the 25 (80%), considered the role of information and technology.”
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Stigma around mental health in the community was identified across studies as a barrier to scaling up mental health services.
“Barriers to scaling up mental health services identified across studies included: stigma around mental health in the community (Ali et al. 2010; Nimgaonkar & Menon, 2015; Padilla et al. 2015);”
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In larger, multi-country studies, lack of clarity in lay provider roles and confidentiality issues undermined integration of programmes from a supply-side perspective.
“In larger, multi-country studies, lack of clarity in lay provider roles and confidentiality issues undermined integration of programmes from a supply-side perspective (Mendenhall et al. 2014).”
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Leadership and governance structures were also barriers to integration.
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Eight included studies touched on efforts made beyond the health sector.
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In addressing disability challenges, social development and transport sectors were involved to make the lived environment more supportive of those living with both physical and mental disabilities.
“In addressing disability challenges, social development and transport sectors were involved to make the lived environment more supportive of those living with both physical and mental disabilities (Lorenzo et al. 2015).”
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Other studies referenced the need for policy support to integrate mental health services by lay providers into existing practice, citing governance structures as facilitators in scale-up and integration through decentralization.
“Other studies referenced the need for policy support to integrate mental health services by lay providers into existing practice, citing governance structures as facilitators in scale-up and integration of mental health services through decentralization of these services (Petersen et al. 2011; Nimgaonkar & Menon, 2015).”
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The evidence base around implementation, scale-up, and integration of task-shifting strategies for mental health remains limited in both quantity and breadth.
“Despite the global call to action to improve scale-up and integration of lay provider programmes, the evidence base around implementation, scale-up, and integration of task-shifting strategies for mental health remains limited in both quantity and breadth (GHWA, 2013; Weinmann & Koesters, 2016).”
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In programmes targeted at vulnerable populations, such as refugees and orphans, continuity was a challenge as these populations are mobile.
“In programmes targeted at vulnerable populations, such as refugees and orphans, continuity was a challenge as these populations are mobile.”
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Four included studies had formal arrangements for embedding intersectoral practice in the task shifting.
“Four studies had formal arrangements for embedding intersectoral practice in the task shifting (Petersen et al. 2011; Lorenzo et al. 2015).”
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One included study highlighted health promotion activities through working with community resources, such as schools and churches, as an enabling factor.
“One study highlighted health promotion activities through working with community resources, such as schools and churches, as an enabling factor (Wright & Chiwandira, 2016).”
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One study highlighted the siloed effect of multiple vertical programmes addressing disability across different sectors with no oversight or horizontal coordination.
“One study highlighted the siloed effect of multiple vertical programmes addressing disability across different sectors with no oversight or horizontal coordination (Lorenzo et al. 2015).”
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Several included studies raised social determinants of mental health, such as socioeconomic status, employment, lack of education, and violence, as risk factors that needed to be addressed to enhance the positive effect of task shifting for mental health.
“Several studies raised social determinants of mental health, such as socioeconomic status, employment, lack of education, and violence as risk factors that needed to be addressed in order to enhance the positive effect of task shifting for mental health (Petersen et al. 2011; Mendenhall et al. 2014; Thurman et al. 2014; Lorenzo et al. 2015; Nimgaonkar & Menon, 2015; Wright & Chiwandira, 2016).”
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System dynamics theory or modelling tools were not directly used in any of the included studies.
“System dynamics theory or modelling tools were not directly used in any of the included studies”
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Six studies took a more comprehensive approach in capturing system implications of the intervention being studied.
“however, six studies took a more comprehensive approach in capturing system implications of the intervention being studied.”
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Many included studies touched upon WHO building blocks of the health system other than service delivery and health workforce.
“None of the included studies systematically studied system elements; however, many touched upon the WHO building blocks of the health system other than those directly related to task shifting (i.e. service delivery and health workforce).”
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None of the included studies systematically studied system elements.
“None of the included studies systematically studied system elements; however, many touched upon the WHO building blocks of the health system other than those directly related to task shifting (i.e. service delivery and health workforce).”
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Information and technology tools appear to be facilitators for optimizing service delivery by lay providers.
“While information and technology tools appear to be facilitators for optimizing service delivery by lay providers, care must be taken in the selection of technology solutions.”
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Lack of access to community resources to support social determinants of mental health was identified across studies as a barrier to scaling up mental health services.
“and lack of access to community resources to support social determinants of mental health (Tomlinson et al. 2011; Thurman et al. 2014; Rotheram-Borus et al. 2015).”
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Gender differences in responding to treatment were identified across studies as a barrier to scaling up mental health services.
“gender differences in responding to treatment (Larson-Stoa et al. 2015);”
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Poor documentation and loss of follow-up due to lack of robust data management and patient management tools was identified across studies as a barrier to scaling up mental health services.
“poor documentation and loss of follow-up due to lack of robust data management and patient management tools (Agyapong et al. 2015b);”
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Even where formal mechanisms are in place for intersectoral collaboration, participation was erratic and uncertain without senior officials present.
“Even where formal mechanisms are in place for intersectoral collaboration (i.e. where formal engagement of health, education and development sectors are embedded in programme design), participation was erratic and uncertain without senior officials present (Petersen et al. 2011).”
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Poor collaboration with spiritual and traditional healers was identified across studies as a barrier to scaling up mental health services.
“poor collaboration with spiritual and traditional healers (Agyapong et al. 2015a);”
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Disconnect between providers and decision makers was identified across studies as a barrier to scaling up mental health services.
“disconnect between providers and decision makers (Agyapong et al. 2015a, 2016; Rotheram-Borus et al. 2015);”
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Integrated interventions that include life skill building for sustainable livelihood practice, social interaction, and self-care were identified across studies as a facilitator to scaling up mental health services.
“integrated interventions that include life skill building for sustainable livelihood practice, social interaction, and self-care (Petersen et al. 2011; Chatterjee et al. 2014);”
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Use of technology and telemedicine to support supervisory practice was identified across studies as a facilitator to scaling up mental health services.
“use of technology and telemedicine to support supervisory practice (Patel et al. 2011; Tomlinson et al. 2011; Magidson et al. 2015; Agyapong et al. 2016);”
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Despite policy support, implementation and scale-up of integrated approaches to strengthening community mental health remains a challenge.
“Despite policy support, implementation and scale-up of integrated approaches to strengthening community mental health remains a challenge (Hanlon et al. 2014).”
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Integration into existing networks with robust service delivery models that support lay providers was identified across studies as a facilitator to scaling up mental health services.
“and integration into existing networks with robust service delivery models that support lay providers (Petersen et al. 2011; Nimgaonkar & Menon, 2015).”
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Suitability of lay providers due to their ability to relate to the community and their patients was identified across studies as a facilitator to scaling up mental health services.
“Facilitators to scaling up mental health services identified across studies included: suitability of lay providers due to their ability to relate to the community and their patients (Baker-Henningham et al. 2005; Padilla et al. 2015; Abas et al. 2016);”
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Existing heavy workload of lay providers was identified across studies as a barrier to scaling up mental health services.
“existing heavy workload of lay providers (Petersen et al. 2011; Hung et al. 2014);”
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Geographic and financial demand-side barriers to access of mental health services were identified across studies as a barrier to scaling up mental health services.
“geographic and financial demand-side barriers to access of mental health services (Baker-Henningham et al. 2005; Petersen et al. 2011; Mendenhall et al. 2014; Agyapong et al. 2015a);”
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Support from specialized mental health professionals was identified across studies as a facilitator to scaling up mental health services.
“support from specialized mental health professionals (Agyapong et al. 2015a, b);”
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Financial and procurement barriers impede access to essential psychotropic medicines, impeding the delivery of appropriate mental health care to those who require pharmacotherapy.
“Financial and procurement barriers impede access to essential psychotropic medicines, impeding the delivery of appropriate mental health care to those who require pharmacotherapy (Agyapong et al. 2015a; Nimgaonkar & Menon, 2015).”
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Few included studies employed task-shifting strategies across other sectors to enhance mental health promotion.
“Few included studies employed task-shifting strategies across other sectors to enhance mental health promotion.”
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Availability and scale-up of essential health services to achieve health system goals is often impeded by health workforce shortages.
“Availability and scale-up of essential health services to achieve health system goals is often impeded by health workforce shortages”
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This is especially true of mental health in low- and middle-income countries, where availability of services is not matched to population needs.
“This is especially true of mental health in low- and middle-income countries (LMICs), where availability of services is not matched to population needs”
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Conditions such as regular supervision, availability of resources and tools, access to medicines, quality training, and exposure to technological updates through in-service training are enabling factors in ensuring successful redistribution of tasks among health workforce teams.
“Conditions such as regular supervision, availability of resources and tools, access to medicines, quality training, and exposure to technological updates through in-service training are enabling factors in ensuring successful redistribution of tasks among health workforce teams”
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Mental health service delivery is highly context-specific with culturally defined interpretations of stigma, trust, and utility affecting success and impact.
“Mental health service delivery is highly context-specific with culturally defined interpretations of stigma, trust, and utility affecting success and impact”
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Perceptions of a loss of hierarchal structures, shift in earnings, and burden of supervision are examples of barriers that higher professional cadres may experience regarding task shifting.
“perceptions of a loss of hierarchal structures, shift in earnings, and burden of supervision are examples of barriers that higher professional cadres may experience regarding task shifting”
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Integration of mental health services into primary care presents a strategic opportunity to overcome some access barriers and reach the largest number of people while minimizing stigma and discrimination.
“Integration of mental health services into primary care presents a strategic opportunity to overcome some of these access barriers and reach the largest number of people while minimizing stigma and discrimination”
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Several systematic reviews have supported the use of task shifting for mental health focused on specific populations, such as people living with HIV/AIDS or mothers with postpartum depression.
“Several systematic reviews have supported the use of task shifting for mental health focused on specific populations, such as with people living with HIV/AIDS or mothers with postpartum depression”
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Buy-in and acceptance of task-shifting interventions across a wide range of stakeholders is important in their success.
“Buy-in and acceptance of task-shifting interventions across a wide range of stakeholders is also important in their success”
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There is a lack of systematic approaches to exploring complexity in the evaluation of task-shifting interventions.
“There is a lack of systematic approaches to exploring complexity in the evaluation of task-shifting interventions.”
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Task shifting requires various parts of the system to be working in harmony in order to be successful.
“Task shifting requires various parts of the system to be working in harmony in order to be successful”
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To ensure that LMICs can expand large-scale mental health strategies and achieve integration into primary care, a system-wide approach can be an effective tool in understanding, evaluating, and implementing bespoke strategies.
“To ensure that LMICs can expand large-scale mental health strategies and achieve integration into primary care, a system-wide approach can be an effective tool in understanding, evaluating, and implementing bespoke strategies”
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- Rests on an assumption: Systems thinking contributes to documenting the system-wide impact of a given intervention, as well as enhancing the ability to predict both intended and unintended consequences of the intervention, critical in designing successful large-scale reform.
- Premisecitation
Moving from fragmentation to integration requires a move beyond issues specific to lay provider programmes, such as remuneration, training, and supervision.
“Moving from fragmentation to integration requires a move beyond issues specific to lay provider programmes, such as remuneration, training, and supervision (Schneider & Lehmann, 2016).”
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Collaboration with the judicial system was important in cases where abuse and neglect were part of the diagnosis.
“Collaboration with the judicial system was also important in cases where abuse and neglect were part of the diagnosis (Murray et al. 2015b).”
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This rich knowledge, combined with appropriate training, puts lay providers in the optimal position to refer patients to relevant social services.
“This rich knowledge, combined with appropriate training, puts them in the optimal position to refer patients to relevant social services (Paudel et al. 2014).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Paudel et al. 2014
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- Premisecitation
Mental health is often a comorbidity in chronic disease management.
“Mental health is often a comorbidity in chronic disease management; training programmes should also prepare lay providers with the knowledge and skills necessary to understand such linkages and to refer appropriately (Rotheram-Borus et al. 2015).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Rotheram-Borus et al. 2015
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- Interpretationcitation
Scaling up mental health treatment by lay providers without addressing access to medicines in parallel will prove unsuccessful by undermining the quality and impact of additional service provision.
“Scaling up mental health treatment by lay providers without addressing access to medicines in parallel will prove unsuccessful by undermining the quality and impact of additional service provision (WHO, 2009).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites WHO, 2009
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- Interpretationcitation
By being community-based and having a deep understanding of community needs and assets, lay providers have an enhanced ability to identify social determinants of mental health within a given context.
“By being community-based and having a deep understanding of community needs and assets, lay providers have an enhanced ability to identify social determinants of mental health within a given context (Richters et al. 2013; Padilla et al. 2015).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Richters et al. 2013
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- cites Padilla et al. 2015
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- Premisecitation
Inefficiencies in the system can also be found in poor access to medicines.
“Inefficiencies in the system can also be found in poor access to medicines (WHO, 2009).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites WHO, 2009
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- Premisecitation
Mental health is rarely an isolated problem.
“Mental health is rarely an isolated problem.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Tomlinson et al. 2011
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- cites Thurman et al. 2014
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- Premisecitation
A study of church-based lay providers showed that higher education was correlated with improved bio-psychosocial perspectives on mental health and fewer displays of stigma-based behaviour.
“A study of church-based lay providers showed that higher education was correlated with improved bio-psychosocial perspectives on mental health and fewer displays of stigma-based behaviour (Iheanacho et al. 2016).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Iheanacho et al. 2016
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- Premisecitation
Important actors overlooked in the traditional model include caregivers, non-governmental entities that support social determinants of mental health, employers, spiritual leaders, and other social sectors.
“Such actors include caregivers, non-governmental entities that support social determinants of mental health, employers, spiritual leaders, and other social sectors (e.g., education, agriculture, transport, social development, etc.) (Schneider & Lehmann, 2016).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Schneider & Lehmann, 2016
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- Classified as probably not a substantial claim. 42
- May combine two claims. 30
- The quote only partly states this claim. 2
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThirty studies were included in the review.
“Thirty studies were included.”
- Also stated in: § Results · plain
“a final set of 30 papers were included”
Quote in the paperNot a substantial claim- Also stated in: § Results · plain
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenNo studies were excluded on the basis of quality.
“No studies were excluded on the basis of quality.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataTwo included papers included economic evaluation.
“Two papers included economic evaluation”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationShortage of medicines and the resulting limitations placed on lay providers were impediments in achieving improved health outcomes and demoralized providers who were unable to provide adequate care.
“Shortage of medicines and the resulting limitations placed on lay providers were impediments in achieving improved health outcomes and demoralized providers who were unable to provide adequate care (Petersen et al. 2011; Nimgaonkar & Menon, 2015).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Petersen et al. 2011
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- cites Nimgaonkar & Menon, 2015
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May combine two claims. The quote only partly states this claim.
FindingcitationAcross the included contexts, community mental health programmes were variable in nature, with some more integrated into existing health systems and others more programme-specific targeting specific at-risk populations.
“Across these different contexts, community mental health programmes were variable in nature with some being more integrated into existing health systems”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Patel et al. 2010b
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- cites Patel et al. 2011
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- cites Petersen et al. 2011
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Findingnone givenOutcome measures used in the included studies included mental health assessment tools such as the 10-item Edinburgh Postnatal Depression Scale (EPDS-10), the Center for Epidemiological Studies Depression Scale (CES-D), Psychiatric Symptom Score, UCLA Post-Traumatic Stress Disorder Reaction Index, Aga Khan University Anxiety and Depression Scale (AKUADS), and the Positive and Negative SyndromeScale
“Outcome measures used included mental health assessment tools, such as the 10-item Edinburgh Postnatal Depression Scale (EPDS-10), the Center for Epidemiological Studies Depression Scale (CES-D), Psychiatric Symptom Score, UCLA Post-Traumatic Stress Disorder Reaction Index, Aga Khan University Anxiety and Depression Scale (AKUADS), and the Positive and Negative Syndrome Scale (PANSS).”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationFacilitators identified to support information and technology needs were the use of step sheets for enhanced fidelity to interventions and training on documentation of patient visits on mobile phones.
“Facilitators identified to support this need were the use of step sheets for enhanced fidelity to interventions and training on documentation of patient visits on mobile phones (Bolton et al. 2014; Rotheram-Borus et al. 2015; Murray et al. 2015b).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Bolton et al. 2014
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- cites Rotheram-Borus et al. 2015
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- cites Murray et al. 2015b
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May combine two claims.
Findingnone givenStudies were conducted in India, Ghana, Zimbabwe, Pakistan, Malawi, South Africa, Uganda, Indonesia, Iraq, Argentina, Botswana, Jamaica, Ethiopia, Zambia, and Thailand, primarily at the district (includes village) level.
“Studies were conducted in India, Ghana, Zimbabwe, Pakistan, Malawi, South Africa, Uganda, Indonesia, Iraq, Argentina, Botswana Jamaica, Ethiopia, Zambia, and Thailand, primarily at the district (includes village) level (see Table 5).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenAll eligible references identified from included articles were already captured in the search.
“However, all eligible references were already captured in the search.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationThe information and technology building block was often mentioned in terms of use of technology for screening of mental illness, use of mobile technology for supervision of lay providers, and need for improved data management tools to ensure adequate follow-up of patients at-risk of poor mental health.
“This building block was often mentioned in terms of use of technology for screening of mental illness (Hung et al. 2014; Padilla et al. 2015), use of mobile technology for supervision of lay providers (Tomlinson et al. 2011; Magidson et al. 2015; Agyapong et al. 2016), and need for improved data management tools to ensure adequate follow-up patients at-risk of poor mental health (Agyapong et al. 2”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Hung et al. 2014
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- cites Padilla et al. 2015
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- cites Tomlinson et al. 2011
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Probably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationProgramme-level supervision of lay providers, raised as a challenge across most included studies, was not captured as an overarching leadership and governance issue in this review because it does not sufficiently address system-level leadership and governance.
“Programme-level supervision of lay providers, which was raised as a challenge across most of the studies included, was not captured as an overarching leadership and governance issue in this review as it is not sufficiently addressing system-level leadership and governance (Schneider & Lehmann, 2016).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Schneider & Lehmann, 2016
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FindingcitationFifteen studies (70%) raised financing issues in task shifting for mental health, with most referring to lack of funds as a limitation to scale-up and pointing to the need to prove cost-effectiveness to ensure investment by policy and decision makers.
“Fifteen studies (70%) raised financing issues in task shifting for mental health with most referring to lack of funds as a limitation to scale-up, pointing to the need to prove cost-effectiveness as a means of ensuring investment by policy and decision makers (Agyapong et al. 2015a, 2016; Murray et al. 2015b).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Agyapong et al. 2015a
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- cites Agyapong et al. 2016
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- cites Murray et al. 2015b
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Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThree included papers were pre/post- or prospective cohort studies.
“Three papers were pre/post- or prospective cohort studies”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenQualitative measures of impact included participatory action research, implementation research, case study, and other qualitative approaches aimed at exploring broader systems components.
“Qualitative measures of impact included participatory action research, implementation research, case study, and other qualitative approaches with an aim to explore broader systems components.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationAnother included study mentioned the lack of collaboration with other sectors as a barrier in seeing improved treatment outcomes.
“Another mentioned the lack of such collaboration with other sectors as a barrier in seeing improved treatment outcomes (Thurman et al. 2014).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Thurman et al. 2014
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May combine two claims.
Findingown dataThe eight included studies with intersectoral components focused on the education sector, non-governmental organizations for vulnerable populations, and criminal and social services sectors.
“These interventions focused on the education sector, where peer group support for AIDS counselling (Kumakech et al. 2009) or support for disability management (Lorenzo et al. 2015) would take place; across non-governmental organizations for vulnerable populations (Bolton et al. 2014); and with the criminal and social services sectors (Murray et al. 2015b).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Kumakech et al. 2009
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- cites Lorenzo et al. 2015
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- cites Murray et al. 2015b
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May combine two claims.
FindingreasoningThese studies demonstrated the range of actors necessary for successful integration and showed that actors may have different interpretations of challenges, and different strengths in mitigating these challenges.
“These studies demonstrated the range of actors necessary for successful integration and showed that actors may have different interpretations of challenges, and different strengths in mitigating these challenges.”
Quote in the paperSubstantial claim- Rests on an assumption: An important element of systems thinking is understanding roles, characteristics, and interactions of the players involved.
May combine two claims.
FindingcitationLeadership and governance issues beyond the health sector played a heavy role in the ability of lay providers to provide necessary mental health services; therefore, collaboration with other officials was raised as being important to the intervention.
“Leadership and governance issues beyond the health sector played a heavy role in the ability of lay providers to provide necessary mental health services; therefore, collaboration with other officials was raised as being important to the intervention (Neuner et al. 2008; Murray et al. 2015b).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Neuner et al. 2008
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- cites Murray et al. 2015b
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FindingcitationOne example of referral is referral of patients to income-generating programmes within the agricultural sector.
“One such example is the referral of patients to income-generating programmes within the agricultural sector (Petersen et al. 2011).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Petersen et al. 2011
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
FindingreasoningThis review demonstrates that there is space for more systematic approaches to studying health systems elements that affect and/or are impacted upon by task-shifting interventions for mental health.
“This review demonstrates that there is space for more systematic approaches to studying health systems elements that affect and/or are impacted upon by task-shifting interventions for mental health.”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationThe included studies used qualitative methods that allowed them to capture some interactions within the system and highlight barriers, facilitators and effects outside the limited scope of the task-shifting intervention.
“These studies included qualitative methods that allowed them to capture some of the interactions within the system and highlight barriers, facilitators and effects that fell outside the limited scope of the task-shifting intervention (Petersen et al. 2011; Lorenzo et al. 2015; Nimgaonkar & Menon, 2015; Padilla et al. 2015; Agyapong et al. 2016).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Petersen et al. 2011
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- cites Lorenzo et al. 2015
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- cites Nimgaonkar & Menon, 2015
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The quote only partly states this claim.
FindingcitationImplementation research methods facilitate a non-linear process of change by feeding study findings back into the design of the intervention, making adjustments for context and cultural needs.
“implementation research methods facilitate this, making adjustments for context and cultural needs”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Mendenhall et al. 2014
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- cites Murray et al. 2014
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- cites Nimgaonkar & Menon, 2015
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- Rests on an assumption: An important element of systems thinking is understanding roles, characteristics, and interactions of the players involved.
May combine two claims.
FindingcitationThe perceptions surveys in Ghana, the phenomenological approach across South Africa, Botswana and Malawi, the multi-country stakeholder perspective mapping, and the cross-country comparison of South Africa and Uganda through interviews and focus groups captured such perspectives and allowed for improved understanding of gaps to ensure successful scale-up and integration into the health system.
“The perceptions surveys conducted in Ghana, the phenomenological approach across South Africa, Botswana and Malawi, the multi-country stakeholder perspective mapping, and the cross-country comparison of South Africa and Uganda through interviews and focus groups captured such perspectives and allowed for improved understanding of gaps to ensure successful scale-up and integration into the health”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Petersen et al. 2011
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- cites Mendenhall et al. 2014
Not checked in the free run.
- cites Agyapong et al. 2015a
Not checked in the free run.
- Rests on an assumption: An important element of systems thinking is understanding roles, characteristics, and interactions of the players involved.
May combine two claims.
FindingcitationLack of access to psychotropic medicines and/or lack of sufficient training for rational prescribing practice was identified across studies as a barrier to scaling up mental health services.
“lack of access to psychotropic medicines and/or lack of sufficient training for rational prescribing practice (Patel et al. 2011; Agyapong et al. 2015a; Nimgaonkar & Menon, 2015);”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Patel et al. 2011
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- cites Agyapong et al. 2015a
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- cites Nimgaonkar & Menon, 2015
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May combine two claims.
Findingnone givenWhile the majority of studies did not explicitly use a systems thinking approach, some studies indicated implicit consideration of systems thinking characteristics.
“While the majority of studies did not explicitly use a systems thinking approach, some studies indicated implicit consideration of systems thinking characteristics.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
Findingnone givenThere is a lack of systematic approaches to exploring this complexity in the evaluation of task-shifting interventions.
“There is a lack of systematic approaches to exploring this complexity in the evaluation of task-shifting interventions.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Findingnone givenThis review shows the complexity of task-shifting interventions by exploring interactions of intervention elements and actors across the six WHO building blocks.
“This review shows the complexity of task-shifting interventions by exploring interactions of intervention elements and actors across the six WHO building blocks.”
Quote in the paperSubstantial claimMay combine two claims.
InterpretationreasoningTask shifting is a system-wide intervention that has implications beyond the players and programmes directly involved in its implementation; it reallocates resources across the health system to trigger change.
“Therefore, task shifting is a system-wide intervention that has implications beyond the players and programmes directly involved in its implementation; it reallocates resources across the health system to trigger change.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationThe six building blocks of the health system are made dynamic, adaptive, and interactive through a systems thinking lens as it is designed to explore how different elements are connected in a system and the impact and implications of these connections.
“The six building blocks of the health system – service delivery, health workforce, information technology, medical products, financing, and leadership – are made dynamic, adaptive, and interactive through a systems thinking lens as it is designed to explore how different elements are connected in a system and the impact and implications of these connections”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Adam et al. 2012
Not checked in the free run.
May combine two claims.
PremisecitationMental and physical health are interconnected, and early detection can lead to improved health outcomes and increase cost-effectiveness for the health system.
“Mental and physical health are interconnected, and early detection can lead to improved health outcomes and increase cost-effectiveness for the health system”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites WONCA, 2008
Not checked in the free run.
- cites Levin & Chisholm, 2015
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May combine two claims.
PremisecitationFew studies focus on the wider impact of task shifting across the health system and, likewise, the scale-up of mental health strategies.
“Few studies focus on the wider impact of task shifting across the health system and, likewise, the scale-up of mental health strategies”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Eaton et al. 2011
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- cites Yaya Bocoum et al. 2013
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May combine two claims.
PremisecitationIn resource-poor settings, task shifting has been an effective approach to addressing health workforce challenges and strengthening systems for mental health.
“In resource-poor settings, task shifting has been an effective approach to addressing health workforce challenges and strengthening systems for mental health”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Eaton et al. 2011
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- cites Kakuma et al. 2011
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InterpretationreasoningThis weakness in the literature undermines the complexity of interactions and changes that take place in health systems, and stymies the potential scale-up and sustainable integration of promising task-shifting strategies.
“This weakness in the literature undermines the complexity of interactions and changes that take place in health systems, and stymies the potential scale-up and sustainable integration of promising task-shifting strategies”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Adam et al. 2012
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- cites Yaya Bocoum et al. 2013
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe World Health Organization estimates that there is a need for 1.18 million mental health workers to move towards closing the mental health treatment gap.
“The World Health Organization (WHO) estimates that there is a need for 1.18 million mental health workers to move towards closing the mental health treatment gap”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Fulton et al. 2011
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationSystems thinking incorporates communities and people as a key health systems element.
“Systems thinking also incorporates another key health systems element: communities and people”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Adam et al. 2012
Not checked in the free run.
May combine two claims.
PremisecitationPoor policy implementation, inadequate human resource allocation to support the process, poor community engagement, and low access to medicines are among the challenges of integration.
“Poor policy implementation, inadequate human resource allocation to support the process, poor community engagement, and low access to medicines are among the challenges of integration”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Patel et al. 2007
Not checked in the free run.
- cites Eaton et al. 2011
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- cites van Ginneken et al. 2013
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIntegration of mental health services requires primary care providers to be trained in identifying poor mental health and taking action towards treatment.
“it requires primary care providers to be trained in identifying poor mental health and taking action towards treatment”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites WONCA, 2008
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
PremisecitationBy enhancing understanding of different perspectives across multiple interacting agents, the changing context in which they interact, and the changes resulting from new patterns created over time, systems thinking can serve as an important policy toolkit.
“By enhancing understanding of different perspectives across multiple interacting agents, the changing context in which they interact, and the changes resulting from new patterns created over time, systems thinking can serve as an important policy toolkit”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Adam et al. 2012
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- cites Peters, 2014
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Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIntegration of mental health into health systems, especially in primary care systems, is not without its challenges, particularly in resource-poor settings.
“Integration of mental health into health systems, especially in primary care systems, is not without its challenges, particularly in resource-poor settings”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Patel et al. 2010a
Not checked in the free run.
- cites Eaton et al. 2011
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- cites Weinmann & Koesters, 2016
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Classified as probably not a substantial claim. May combine two claims.
PremisecitationOnly 20% of persons with common mental disorders received treatment in the year prior to the survey, with only 10% receiving minimally adequate treatment.
“only 20% of persons with common mental disorders (CMDs) received treatment in the year prior to the survey, with only 10% receiving minimally adequate treatment”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Wang et al. 2007
Not checked in the free run.
May combine two claims.
PremisecitationIn LMICs, not only are there limited mental health services available, utilization of existing services is also poor for a multitude of reasons, including geographic, cultural, and financial access barriers.
“In LMICs, not only are there limited mental health services available, utilization of existing services is also poor for a multitude of reasons, including geographic, cultural, and financial access barriers”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Murthy, 2011 source
Not checked in the free run.
- cites van Ginneken et al. 2013
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- cites Chowdhary et al. 2014
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenTwo study authors read all included full texts and extracted data.
“Two study authors read all included full texts and extracted the following data”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationCritical Appraisal Skills Programme tools were used to assess the quality of included studies.
“Critical Appraisal Skills Programme (CASP) tools were used to assess the quality of the studies”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites CASP, 2016
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningThe references of included articles were searched to identify additional citations not captured in the search.
“Further, the references of included articles were searched to identify additional citations that were not captured in the search as a means of ensuring the robustness of the study.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenA third reviewer, blinded and with expertise in health systems research, resolved inter-rater disagreements.
“In the case of inter-rater disagreement, a third reviewer was consulted on the inclusion or exclusion of the article in question. The third reviewer was blinded and has expertise in health systems research.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataRisk of bias and limitations of included studies were assessed using more detailed items found on CASP checklists.
“Risk of bias and limitations of included studies were then assessed using more detailed items found on CASP checklists”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenWhere length of training was not specified, the authors used collective judgment to determine whether task shifting was towards a provider with minimal mental health training.
“Where length of training was not specified, we used our collective judgment to determine whether task shifting was towards a provider with minimal mental health training.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductreasoningA meta-analysis of outcome measures was not done because the interventions were diverse, conducted at multiple scales, and included qualitative evaluations of stakeholder perceptions.
“A meta-analysis of outcome measures was not done as the interventions were diverse, conducted at multiple scales, and included qualitative evaluations of stakeholder perceptions.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataBy looking at the level and range of stakeholder engagement, the authors were able to identify instances where roles and interactions of stakeholders not directly involved in the intervention were explored.
“By looking at the level and range of stakeholder engagement, we were able to identify instances were roles and interactions of stakeholders not directly involved in the intervention were explored”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenA two-stage approach to inclusion was employed to ensure sensitivity.
“Two stages of screens were done to ensure sensitivity.”
- Also stated in: § Search strategy · plain
“A two-stage approach to inclusion was employed to ensure sensitivity.”
Quote in the paperNot a substantial claim- Also stated in: § Search strategy · plain
Classified as probably not a substantial claim.
Study design and conductreasoningThe building blocks model allowed for a systematic way to determine whether the impact of the intervention was assessed beyond the specific building blocks in which it was implemented.
“The building blocks model allowed for a systematic way to determine whether the impact of the intervention was assessed beyond the specific building blocks in which they were implemented”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataTitles and abstracts of all identified articles were independently reviewed by two authors.
“Articles were screened by two independent reviewers with a third reviewer resolving discrepancies.”
- Also stated in: § Search strategy · plain
“the titles and abstracts of all identified articles were independently reviewed by two authors”
Quote in the paperNot a substantial claim- Also stated in: § Search strategy · plain
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe training criteria was articulated with input from a health workforce specialist.
“The training criteria was articulated with input from a health workforce specialist”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationcitationThe intersectoral fora created to support these programmes strengthened their ability to integrate into existing systems and provided a wider range of community referral pathways for lay providers, thereby indirectly enhancing mental health.
“The intersectoral fora created to support these programmes strengthened their ability to integrate into existing systems and provided a wider range of community referral pathways for lay providers to use in linking their patients to the resources necessary for thriving, thereby indirectly enhancing mental health (Petersen et al. 2011; Chatterjee et al. 2014; Lorenzo et al. 2015).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Petersen et al. 2011
Not checked in the free run.
- cites Chatterjee et al. 2014
Not checked in the free run.
- cites Lorenzo et al. 2015
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
PremisecitationA systems thinking approach can help capture these complexities and understand how to optimize community mental health systems.
“A systems thinking approach can help capture these complexities and understand how to optimize community mental health systems (Peters, 2014).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Peters, 2014
Not checked in the free run.
May combine two claims.
PremisecitationIn community mental health, robust referral pathways are an important piece of integration and working across stakeholders is necessary to ensure appropriate follow-up and service delivery for patients across health and other social sectors.
“In community mental health, robust referral pathways are an important piece of integration and working across stakeholders is necessary to ensure appropriate follow-up and service delivery for patients, not just within the health system, but also across other social sectors (Petersen et al. 2011; Lorenzo et al. 2015).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Petersen et al. 2011
Not checked in the free run.
- cites Lorenzo et al. 2015
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Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
PremisecitationIntegration needs an understanding of large-scale public sector involvement, interactions across key actors, mobilization of these actors, and monitoring and evaluation tools that capture complex adaptive parts within the system.
“It needs an understanding of large-scale public sector involvement, interactions across key actors, mobilization of these actors, and monitoring and evaluation tools that capture the complex adaptive parts within the system as they shift and respond to scale-up toward a true community system (Hanlon et al. 2014; Schneider & Lehmann, 2016).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Hanlon et al. 2014
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- cites Schneider & Lehmann, 2016
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May combine two claims.
InterpretationcitationSome tools require the interpretation and training of health professionals to be appropriately and efficiently used, suggesting that not all technologies are readily transferable across health workforce cadres.
“Some tools require the interpretation and training of health professionals to be appropriately and efficiently used, suggesting that not all technologies are readily transferable across health workforce cadres (Jotheeswaran et al. 2015; Robbins et al. 2015).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Jotheeswaran et al. 2015
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- cites Robbins et al. 2015
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May combine two claims.
PremisecitationMental health sometimes stems from physical, environmental, or sociocultural challenges and creates positive feedback loops that become difficult to break.
“It sometimes stems from physical, environmental, or sociocultural challenges and creates positive feedback loops that become difficult to break (Tomlinson et al. 2011; Thurman et al. 2014).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Tomlinson et al. 2011
Not checked in the free run.
- cites Thurman et al. 2014
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningExisting models and formal arrangements of intersectoral collaboration require additional incentives and governmental support.
“Existing models and formal arrangements of intersectoral collaboration require additional incentives and governmental support.”
Quote in the paperNot a substantial claim- Rests on an assumption: Establishing networks and intersectoral linkages is not easy.
Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationreasoningThe barriers and facilitators outlined showcase the complexity involved in task shifting for mental health and the need for a broader systems approach to mitigating barriers and leveraging facilitators.
“The barriers and facilitators outlined here showcase the complexity involved in task shifting for mental health and the need for a broader systems approach to mitigating barriers and leveraging facilitators.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductreasoningDue to the nature of the search strategy, this review highlighted interventions that were conducted primarily in the health sector.
“Due to the nature of the search strategy, this review highlighted interventions that were conducted primarily in the health sector.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
InterpretationreasoningTaking a systems thinking approach to unpacking task-shifting interventions for mental health will unveil extant opportunities and threats in the current system.
“Taking a systems thinking approach to unpacking task-shifting interventions for mental health will unveil extant opportunities and threats in the current system.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningOvercoming stigma is not necessarily limited to the role of the health sector; the education sector can play an important part in addressing stigma by talking about mental health and raising awareness.
“Overcoming stigma is therefore not necessarily limited to the role of the health sector; the education sector can play an important part in addressing stigma by talking about mental health and raising awareness.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningLimitations of this review may include the wide variety of mental health interventions, populations studied, and outcome measures included, making it potentially difficult or inappropriate to apply this review's broader conclusions to unique mental health conditions.
“Limitations of this review may include the wide variety of mental health interventions, populations studied, and outcome measures included, making it potentially difficult or inappropriate to apply this review's broader conclusions to unique mental health conditions.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.
InterpretationreasoningWith appropriate evidence describing the roles and contributions of diverse sectors to mental health outcomes, there is potential to facilitate strategic intersectoral investment for optimal health impact as well as cost-effectiveness.
“With appropriate evidence describing the roles and contributions of diverse sectors to mental health outcomes, there is potential to facilitate strategic intersectoral investment for optimal health impact as well as cost-effectiveness.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based).
InterpretationreasoningA system-level understanding of interventions will allow for improved integration and effective engagement of important actors overlooked in the traditional model of implementation and evaluation.
“A system-level understanding of interventions will allow for improved integration and effective engagement of important actors overlooked in the traditional model of implementation and evaluation.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationStigma is an often-cited barrier in mental health seeking behaviours and in provision of mental health care.
“Stigma, for instance, is an often-cited barrier in mental health seeking behaviours and even in provision of mental health care (van Ginneken et al. 2013; Nimgaonkar & Menon, 2015; Iheanacho et al. 2016; Weinmann & Koesters, 2016).”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites van Ginneken et al. 2013
Not checked in the free run.
- cites Nimgaonkar & Menon, 2015
Not checked in the free run.
- cites Iheanacho et al. 2016
Not checked in the free run.
May combine two claims.
Interpretationnone givenTask shifting for mental health has been demonstrated as an acceptable and effective approach to addressing the mental health gap in LMICs.
“Task shifting for mental health has been demonstrated as an acceptable and effective approach to addressing the mental health gap in LMICs.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Effective integration of mental health into primary care requires strengthened primary care systems.
“However, effective integration requires strengthened primary care systems.”
The paper relies on this without support.
Systems thinking contributes to documenting the system-wide impact of a given intervention, as well as enhancing the ability to predict both intended and unintended consequences of the intervention, critical in designing successful large-scale reform.
“Systems thinking contributes to documenting the system-wide impact of a given intervention, as well as enhancing the ability to predict both intended and unintended consequences of the intervention, critical in designing successful large-scale reform.”
The paper relies on this without support.
An important element of systems thinking is understanding roles, characteristics, and interactions of the players involved.
“An important element of systems thinking is understanding roles, characteristics, and interactions of the players involved.”
The paper relies on this without support.
More examples of intersectoral collaboration exist, especially in education and social services.
“More examples of such collaboration exist, especially in education and social services.”
The paper relies on this without support.
Establishing networks and intersectoral linkages is not easy.
“Establishing networks and intersectoral linkages is not easy.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
These and other reviews have not been explicitly situated in an implementation science framework, limiting the applicability of the results to other task-sharing interventions, models, or settings.
“Additionally, these and other reviews (for example, see [23]) have not been explicitly situated in an implementation science framework, limiting the applicability of the results to other task-sharing interventions, models, or settings.”
From Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks (2022) · cites this paper as [23]
The Methods (Data extraction and analysis) situate the review in a systems-thinking approach and the WHO health-system building-blocks framework, rather than an explicitly named implementation science framework. The Discussion (Implications for future research) cautions that its conclusions may be difficult to apply to unique mental health conditions, but attributes that limitation to the variety of interventions, populations, and outcomes—not to the absence of an implementation science framework or to applicability across other task-sharing models and settings. (LLM, conf=0.83)
Experimental — accuracy not yet measuredTask-shifting, in which delivery of an EBP is accomplished by lower-level and lower-cost staff such as community health workers or peer coaches, is sometimes used to reduce costs.
“This is sometimes achieved by the use of “task-shifting” in which delivery of an EBP is accomplished by much lower level—and thus lower cost—staff members such as community health workers or peer coaches [29].”
From Implementation science issues in understanding, collecting, and using cost estimates: A multi-stakeholder perspective (2021) · cites this paper as [29]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Randomized-trial arm sizes exceed the reported total
MajorThe reported intervention and control groups sum to 347 participants, not the stated total of 247.
Reported 247 · recomputed 347
“247 participants (intervention n = 182; wait list controlled n = 165)”
Information and technology percentage is incorrect
MinorSixteen of 25 studies is 64%, not 80%.
Reported 80 · recomputed 64
“Sixteen studies of the 25 (80%), considered the role of information and technology.”
Three cohort or pre/post papers are claimed, but five are listed
MinorThe sentence describes three papers while naming five distinct papers in its supporting citations.
“Three papers were pre/post- or prospective cohort studies”
“(Adam et al. 2012; Whiteford et al. 2013; Yaya Bocoum et al. 2013; Hung et al. 2014; Padilla et al. 2015).”
Financing percentage is incorrect
MinorUsing the stated denominator of 25 studies, 15 studies represent 60%, not 70%.
Reported 70 · recomputed 60
“Fifteen studies (70%) raised financing issues in task shifting for mental health”
Medicines and medical devices percentage is incorrect
MinorUsing the stated denominator of 25 studies, 11 studies represent 44%, not 55%.
Reported 55 · recomputed 44
“Eleven studies (55%) considered the implications of the medicines and medical devices.”
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“Three papers were pre/post- or prospective cohort studies (Adam et al. 2012; Whiteford et al. 2013; Yaya Bocoum et al. 2013; Hung et al. 2014; Padilla et al. 2015).”
BackgroundThe World Health report 2006 1 : Working together for health 2
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“Availability and scale-up of essential health services to achieve health system goals is often impeded by health workforce shortages (WHO, 2006).”
BackgroundMurray, C. J. L., Barber, R. M., Foreman, K. J., Özgören, A. A., Abd-Allah, F., Abera, S. F., Aboyans, V., Abraham, J. P., Abubakar, I., Abu-Raddad, L. J., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)61340-x · Cited by 1,966 · cited 9× · see citing works
“(Continued) globalm entalhealth orphans, refugees and torture survivors (BakerHenningham et al. 2005; Neuner et al. 2008; Kumakech et al. 2009; Ali et al. 2010; Bolton et al. 2014; Murray et al. 2014; Larson-Stoa et al. 2015; Magidson et al. 2015; Murray et al. 2015b).”
InfluentialThe global burden of mental disorders: An update from the WHO World Mental Health (WMH) surveys
Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Chatterji, S., Lee, S., Ormel, J., Üstün, T. B., & Wang, P. S. (2009) · Epidemiologia e Psichiatria Sociale · doi:10.1017/s1121189x00001421 · Cited by 1,895 · cited 1× · see citing works
“Recent estimates from the WHO Mental Health Surveys indicate an interquartile range of lifetime DSM-IV disorder prevalence between 18.1% and 36.1% (Kessler et al. 2009).”
BackgroundInfluentialWang, P. S., Aguilar-Gaxiola, S., Alonso, J., Angermeyer, M. C., Borges, G., Bromet, E. J., Bruffaerts, R., de Girolamo, G., de Graaf, R., Gureje, O., et al. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61414-7 · Cited by 1,655 · see citing works
Gene-Wide Analysis Detects Two New Susceptibility Genes for Alzheimer's Disease
Escott-Price, V., Bellenguez, C., Wang, L.-S., Choi, S.-H., Harold, D., Jones, L., Holmans, P., Gerrish, A., Vedernikov, A., Richards, A., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0094661 · Cited by 1,398 · see citing works
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“Twelve papers were randomized controlled trials (Ali et al. 2003; Baker-Henningham et al. 2005; Rahman et al. 2008; Kumakech et al. 2009; Patel et al. 2010b, 2011; Tomlinson et al. 2011; Chatterjee et al. 2014; Pradeep et al. 2014; RotheramBorus et al. 2015).”
BackgroundMethodHuman resources for mental health care: current situation and strategies for action
Kakuma, R., Minas, H., van Ginneken, N., Dal Poz, M. R., Desiraju, K., Morris, J. E., Saxena, S., & Scheffler, R. M. (2011) · The Lancet · doi:10.1016/s0140-6736(11)61093-3 · Cited by 979 · cited 2× · see citing works
“Recognizing task shifting as a system intervention for mental health In resource-poor settings, task shifting has been an effective approach to addressing health workforce challenges and strengthening systems for mental health (Eaton et al. 2011; Kakuma et al. 2011).”
BackgroundTreatment and prevention of mental disorders in low-income and middle-income countries
Patel, V., Araya, R., Chatterjee, S., Chisholm, D., Cohen, A., De Silva, M., Hosman, C., McGuire, H., Rojas, G., & van Ommeren, M. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61240-9 · Cited by 930 · cited 3× · see citing works
“Global mental health has seen attention in academic circles through special series in The Lancet and PLoS, which highlight integration of mental health into primary care as a key strategy (Patel et al. 2007; Patel & Thornicroft, 2009).”
BackgroundPatel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., De Silva, M. J., Bhat, B., Araya, R., King, M., et al. (2010) · The Lancet · doi:10.1016/s0140-6736(10)61508-5 · Cited by 752 · cited 18× · see citing works
“Was an adequate sensitivity analysis performed? global mental health included although two of these reported on the same randomized controlled trial on MANAS in India (Patel et al. 2010b, 2011), and three were based on different perspectives of the community mental health programme in Ghana (Agyapong et al. 2015a, b,…”
BackgroundInfluentialScale up of services for mental health in low-income and middle-income countries
Eaton, J., McCay, L., Semrau, M., Chatterjee, S., Baingana, F., Araya, R., Ntulo, C., Thornicroft, G., & Saxena, S. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60891-x · Cited by 698 · cited 5× · see citing works
“In resource-poor settings, task shifting has been an effective approach to addressing health workforce challenges and strengthening systems for mental health (Eaton et al. 2011; Kakuma et al. 2011).”
BackgroundInfluentialThe application of systems thinking in health: why use systems thinking?
Peters, D. H. (2014) · Health Research Policy and Systems · doi:10.1186/1478-4505-12-51 · Cited by 616 · cited 5× · see citing works
“Systems thinking characteristics considered included: capturing perceptions and interactions of multiple interacting agents, network analysis, mapping of contextual factors, process mapping, describing feedback mechanisms, and other approaches that could inform system dynamics modelling (Peters, 2014).”
BackgroundInfluentialJoshi, R., Alim, M., Kengne, A. P., Jan, S., Maulik, P. K., Peiris, D., & Patel, A. A. (2014) · PLoS ONE · doi:10.1371/journal.pone.0103754 · Cited by 589 · cited 2× · see citing works
“…health services available, utilization of existing services is also poor for a multitude of reasons, including geographic, cultural, and financial access barriers (Murthy, 2011; van Ginneken et al. 2013; Chowdhary et al. 2014; Joshi et al. 2014; Chibanda et al. 2015; Weinmann & Koesters, 2016).”
Backgroundvan Ginneken, N., Tharyan, P., Lewin, S., Rao, G. N., Meera, S., Pian, J., Chandrashekar, S., & Patel, V. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009149.pub2 · Cited by 575 · cited 5× · see citing works
“Mental health service delivery is highly context-specific with culturally defined interpretations of stigma, trust, and utility affecting success and impact (Murthy, 2011; van Ginneken et al. 2013; Weinmann & Koesters, 2016).”
InfluentialHealth workforce skill mix and task shifting in low income countries: a review of recent evidence
Fulton, B. D., Scheffler, R. M., Sparkes, S. P., Auh, E. Y., Vujicic, M., & Soucat, A. L. B. (2011) · Human Resources for Health · doi:10.1186/1478-4491-9-1 · Cited by 542 · cited 2× · see citing works
“18 million mental health workers to move towards closing the mental health treatment gap (Fulton et al. 2011).”
BackgroundInfluentialReducing the treatment gap for mental disorders: a WPA survey
PATEL, V., MAJ, M., FLISHER, A. J., DE SILVA, M. J., KOSCHORKE, M., PRINCE, M., WPA Zonal and Member Society Representatives, Tempier, R., Riba, M., Sanchez, M., et al. (2010) · World Psychiatry · doi:10.1002/j.2051-5545.2010.tb00305.x · Cited by 420 · cited 18× · see citing works
“Was an adequate sensitivity analysis performed? global mental health included although two of these reported on the same randomized controlled trial on MANAS in India (Patel et al. 2010b, 2011), and three were based on different perspectives of the community mental health programme in Ghana (Agyapong et al. 2015a, b,…”
BackgroundInfluentialWho is a community health worker? – a systematic review of definitions
Olaniran, A., Smith, H. J. J., Unkels, R., Bar‐Zeev, S., & van den Broek, N. R. (2017) · Global Health Action · doi:10.1080/16549716.2017.1272223 · Cited by 420 · see citing works
Murray, L. K., Dorsey, S., Haroz, E. E., Lee, C., Alsiary, M. M., Haydary, A., Weiss, W. M., & Bolton, P. A. (2013) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2013.06.005 · Cited by 404 · see citing works
Rahman, A., Fisher, J., Bower, P., Luchters, S., Tran, T., Yasamy, M. T., Saxena, S., & Waheed, W. (2013) · Bulletin of the World Health Organization · doi:10.2471/blt.12.109819 · Cited by 403 · cited 2× · see citing works
“Several systematic reviews have supported the use of task shifting for mental health focused on specific populations, such as with people living with HIV/AIDS or mothers with postpartum depression (Rahman et al. 2013; van Ginneken et al. 2013; Chowdhary et al. 2014; Atif et al. 2015; Chibanda et al. 2015).”
BackgroundNeuner, F., Onyut, P. L., Ertl, V., Odenwald, M., Schauer, E., & Elbert, T. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.4.686 · Cited by 395 · cited 6× · see citing works
“Some studies mentioned demandside financing as a barrier to improved mental health delivery, citing the ability to pay for basic mental health services from the patient’s perspective (Neuner et al. 2008; Nimgaonkar & Menon, 2015; Abas et al. 2016).”
BackgroundMethodInfluentialTask shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa
Zachariah, R., Ford, N. P., Philips, M. P., Lynch, S., Massaquoi, M. B. F., Janssens, V., & Harries, A. D. (2008) · Transactions of the Royal Society of Tropical Medicine and Hygiene · doi:10.1016/j.trstmh.2008.09.019 · Cited by 393 · cited 1× · see citing works
“For example, perceptions of a loss of hierarchal structures, shift in earnings, and burden of supervision are examples of barriers that higher professional cadres may experience regarding task shifting (Niekerk, 2008; Philips et al. 2008; Zachariah et al. 2009).”
BackgroundMendenhall, E., De Silva, M. J., Hanlon, C., Petersen, I., Shidhaye, R., Jordans, M., Luitel, N., Ssebunnya, J., Fekadu, A., Patel, V., et al. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.07.057 · Cited by 355 · cited 11× · see citing works
“…Menon, 2015); geographic and financial demand-side barriers to access of mental health services (Baker-Henningham et al. 2005; Petersen et al. 2011; Mendenhall et al. 2014; Agyapong et al. 2015a); poor collaboration with spiritual and traditional healers (Agyapong et al. 2015a); disconnect between…”
BackgroundInfluentialHanlon, C., Luitel, N. P., Kathree, T., Murhar, V., Shrivasta, S., Medhin, G., Ssebunnya, J., Fekadu, A., Shidhaye, R., Petersen, I., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0088437 · Cited by 339 · cited 2× · see citing works
“…sector involvement, interactions across key actors, mobilization of these actors, and monitoring and evaluation tools that capture the complex adaptive parts within the system as they shift and respond to scale-up toward a true community system (Hanlon et al. 2014; Schneider & Lehmann, 2016).”
BackgroundBolton, P., Lee, C., Haroz, E. E., Murray, L., Dorsey, S., Robinson, C., Ugueto, A. M., & Bass, J. (2014) · PLoS Medicine · doi:10.1371/journal.pmed.1001757 · Cited by 319 · cited 7× · see citing works
“2015) would take place; across non-governmental organizations for vulnerable populations (Bolton et al. 2014); and with the criminal and social services sectors (Murray et al.”
BackgroundMethodInfluentialChatterjee, S., Naik, S., John, S., Dabholkar, H., Balaji, M., Koschorke, M., Varghese, M., THARA, R., Weiss, H. A., Williams, P. R., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(13)62629-x · Cited by 317 · see citing works
Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., Bhat, B., Araya, R., King, M., Simon, G., et al. (2011) · British Journal of Psychiatry · doi:10.1192/bjp.bp.111.092155 · Cited by 291 · cited 22× · see citing works
“2015b); lack of access to psychotropic medicines and/or lack of sufficient training for rational prescribing practice (Patel et al. 2011; Agyapong et al. 2015a; Nimgaonkar & Menon, 2015); geographic and financial demand-side barriers to access of mental health services (Baker-Henningham et al.”
BackgroundResultInfluentialSymptom burden in community-dwelling older people with multimorbidity: a cross-sectional study
Eckerblad, J., Theander, K., Ekdahl, A., Unosson, M., Wiréhn, A.-B., Milberg, A., Krevers, B., & Jaarsma, T. (2015) · BMC Geriatrics · doi:10.1186/1471-2318-15-1 · Cited by 277 · see citing works
Patel, V., & Thornicroft, G. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000160 · Cited by 237 · cited 1× · see citing works
“Global mental health has seen attention in academic circles through special series in The Lancet and PLoS, which highlight integration of mental health into primary care as a key strategy (Patel et al. 2007; Patel & Thornicroft, 2009).”
BackgroundMurray, L. K., Skavenski, S. V. W., Kane, J. C., Mayeya, J., Dorsey, S., Cohen, J., Michalopoulos, L., Imasiku, M. L., & Bolton, P. A. (2015) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2015.0580 · Cited by 217 · cited 12× · see citing works
“2014); and with the criminal and social services sectors (Murray et al. 2015b).”
BackgroundMethodInfluentialMaternal mental health: The missing “m” in the global maternal and child health agenda
Atif, N., Lovell, K., & Rahman, A. (2015) · Seminars in Perinatology · doi:10.1053/j.semperi.2015.06.007 · Cited by 191 · cited 2× · see citing works
“Several systematic reviews have supported the use of task shifting for mental health focused on specific populations, such as with people living with HIV/AIDS or mothers with postpartum depression (Rahman et al. 2013; van Ginneken et al. 2013; Chowdhary et al. 2014; Atif et al. 2015; Chibanda et al. 2015).”
BackgroundChowdhary, N., Sikander, S., Atif, N., Singh, N., Ahmad, I., Fuhr, D. C., Rahman, A., & Patel, V. (2014) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2013.08.013 · Cited by 183 · cited 4× · see citing works
“…health services available, utilization of existing services is also poor for a multitude of reasons, including geographic, cultural, and financial access barriers (Murthy, 2011; van Ginneken et al. 2013; Chowdhary et al. 2014; Joshi et al. 2014; Chibanda et al. 2015; Weinmann & Koesters, 2016).”
BackgroundInfluentialEconomic evaluation of a task-shifting intervention for common mental disorders in India
Buttorff, C., Hock, R., Weiss, H., Naik, S., Araya, R., Kirkwood, B., Chisholm, D., & Patel, V. (2012) · Bulletin of the World Health Organization · doi:10.2471/blt.12.104133 · Cited by 175 · cited 8× · see citing works
“Data management tools need improvement Links to income-generation projects for patients Agyapong et al. (2015b) (I) SD, HRH, IT, C Poor documentation Agyapong et al. (2015a) (II) SD, HRH, IT, MD, FS, LG, C Lack of training in psychotropic medicine & inappropriate prescribing practice; demand-side financing Involvement…”
BackgroundMethodInfluentialFrom Community Health Workers to Community Health Systems: Time to Widen the Horizon?
Schneider, H. M., & Lehmann, U. (2016) · Health Systems & Reform · doi:10.1080/23288604.2016.1166307 · Cited by 165 · cited 5× · see citing works
“Such actors include caregivers, nongovernmental entities that support social determinants of mental health, employers, spiritual leaders, and other social sectors (e.g., education, agriculture, transport, social development, etc.) (Schneider & Lehmann, 2016).”
BackgroundInfluentialAdam, T., Hsu, J., de Savigny, D., Lavis, J. N., Røttingen, J., & Bennett, S. (2012) · Health Policy and Planning · doi:10.1093/heapol/czs086 · Cited by 161 · cited 7× · see citing works
“Three papers were pre/post- or prospective cohort studies (Adam et al. 2012; Whiteford et al. 2013; Yaya Bocoum et al. 2013; Hung et al. 2014; Padilla et al. 2015).”
BackgroundInfluentialKumakech, E., Cantor‐Graae, E., Maling, S., & Bajunirwe, F. (2009) · Social Science & Medicine · doi:10.1016/j.socscimed.2008.10.033 · Cited by 148 · cited 6× · see citing works
“(Continued) globalm entalhealth orphans, refugees and torture survivors (BakerHenningham et al. 2005; Neuner et al. 2008; Kumakech et al. 2009; Ali et al. 2010; Bolton et al. 2014; Murray et al. 2014; Larson-Stoa et al. 2015; Magidson et al. 2015; Murray et al. 2015b).”
BackgroundInfluentialMental health service provision in low and middle-income countries
Weinmann, S., & Koesters, M. (2016) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000256 · Cited by 144 · cited 7× · see citing works
“By shifting service delivery for less complex cases to lay providers, the system allows mental health specialists to focus on more complex cases with the hope that quality of care delivery will also improve (Weinmann & Koesters, 2016).”
BackgroundInfluentialZheng, C., Hu, M., & Gao, F. (2017) · Global Health Action · doi:10.1080/16549716.2016.1264702 · Cited by 138 · see citing works
Task shifting for antiretroviral treatment delivery in sub-Saharan Africa: not a panacea
Philips, M. P., Zachariah, R., & Venis, S. (2008) · The Lancet · doi:10.1016/s0140-6736(08)60307-4 · Cited by 130 · cited 1× · see citing works
“For example, perceptions of a loss of hierarchal structures, shift in earnings, and burden of supervision are examples of barriers that higher professional cadres may experience regarding task shifting (Niekerk, 2008; Philips et al. 2008; Zachariah et al. 2009).”
BackgroundPetersen, I., Ssebunnya, J., Bhana, A., Baillie, K., & MhaPP Research Programme Consortium (2011) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-5-8 · Cited by 125 · cited 31× · see citing works
“Across these different contexts, community mental health programmes were variable in nature with some being more integrated into existing health systems (Patel et al. 2010b, 2011; Petersen et al. 2011; Mendenhall et al. 2014; Agyapong et al. 2015a, b; Nimgaonkar & Menon, 2015; Agyapong et al. 2016; Wright & Chiwandira…”
BackgroundMethodInfluentialThe effect of early stimulation on maternal depression: a cluster randomised controlled trial
Baker‐Henningham, H. (2005) · Archives of Disease in Childhood · doi:10.1136/adc.2005.073015 · Cited by 122 · cited 7× · see citing works
“2015a; Nimgaonkar & Menon, 2015); geographic and financial demand-side barriers to access of mental health services (Baker-Henningham et al. 2005; Petersen et al. 2011; Mendenhall et al. 2014; Agyapong et al. 2015a); poor collaboration with spiritual and traditional healers (Agyapong et al.”
BackgroundInfluentialAli, B. S., Rahbar, M. H., Naeem, S., Gul, A., Mubeen, S., & Iqbal, A. (2003) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.2003.57.3.324 · Cited by 120 · cited 2× · see citing works
“Further investment in supervision and training is necessary Ali et al. (2003) Randomized controlled trial Pakistan Women briefly trained from the same community Supportive, problem-solving counselling was provided to women with depression in their homes for eight sessions 124 depressed women Based…”
BackgroundMethodAbas, M., Bowers, T., Manda, E., Cooper, S., Machando, D., Verhey, R., Lamech, N., Araya, R., & Chibanda, D. (2016) · International Journal of Mental Health Systems · doi:10.1186/s13033-016-0071-9 · Cited by 114 · cited 14× · see citing works
“Some studies mentioned demandside financing as a barrier to improved mental health delivery, citing the ability to pay for basic mental health services from the patient’s perspective (Neuner et al. 2008; Nimgaonkar & Menon, 2015; Abas et al. 2016).”
BackgroundMethodInfluentialKutcher, S., Gilberds, H., Morgan, C., Greene, R., Hamwaka, K., & Perkins, K. (2015) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2014.8 · Cited by 94 · see citing works
Chibanda, D., Cowan, F. M., Healy, J. L., Abas, M., & Lund, C. (2015) · Tropical Medicine & International Health · doi:10.1111/tmi.12500 · Cited by 87 · cited 4× · see citing works
“…health services available, utilization of existing services is also poor for a multitude of reasons, including geographic, cultural, and financial access barriers (Murthy, 2011; van Ginneken et al. 2013; Chowdhary et al. 2014; Joshi et al. 2014; Chibanda et al. 2015; Weinmann & Koesters, 2016).”
BackgroundInfluentialAlcohol Use, Partner Violence, and Depression
Rotheram-Borus, M. J., Tomlinson, M., Roux, I. L., & Stein, J. A. (2015) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2015.05.004 · Cited by 71 · cited 9× · see citing works
“…with spiritual and traditional healers (Agyapong et al. 2015a); disconnect between providers and decision makers (Agyapong et al. 2015a, 2016; Rotheram-Borus et al. 2015); existing heavy workload of lay providers (Petersen et al. 2011; Hung et al. 2014); gender differences in responding to…”
BackgroundInfluentialFinancing mental health services in low- and middle-income countries
Dixon, A. (2006) · Health Policy and Planning · doi:10.1093/heapol/czl004 · Cited by 68 · see citing works
Community‐based prenatal screening for postpartum depression in a South African township
Hung, K. J., Tomlinson, M., le Roux, I. M., Dewing, S., Chopra, M., & Tsai, A. C. (2014) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2014.01.011 · Cited by 47 · cited 7× · see citing works
“Three papers were pre/post- or prospective cohort studies (Adam et al. 2012; Whiteford et al. 2013; Yaya Bocoum et al. 2013; Hung et al. 2014; Padilla et al. 2015).”
BackgroundInfluentialEnhancing Lay Counselor Capacity to Improve Patient Outcomes with Multimedia Technology
Robbins, R. N., Mellins, C. A., Leu, C., Rowe, J. C., Warne, P. A., Abrams, E. J., Witte, S. S., Stein, D. J., & Remien, R. H. (2015) · AIDS and Behavior · doi:10.1007/s10461-014-0988-4 · Cited by 46 · cited 1× · see citing works
“Some tools require the interpretation and training of health professionals to be appropriately and efficiently used, suggesting that not all technologies are readily transferable across health workforce cadres (Jotheeswaran et al. 2015; Robbins et al. 2015).”
BackgroundLorenzo, T., van Pletzen, E., & Booyens, M. (2015) · Rural and Remote Health · doi:10.22605/rrh2919 · Cited by 43 · cited 19× · see citing works
“Thirteen papers were qualitative evaluations using surveys, interviews, focus groups, action research, implementation research, or case study methodology (Ali et al. 2010; Petersen et al. 2011; Thurman et al. 2014; Agyapong et al. 2015a, b, 2016; Larson-Stoa et al. 2015; Lorenzo et al. 2015; Magidson et al. 2015; Nimg…”
BackgroundMethodInfluentialAgyapong, V. I. O., Osei, A. O., Farren, C. K., & McAuliffe, É. (2015) · Global Health Action · doi:10.3402/gha.v8.28955 · Cited by 42 · cited 30× · see citing works
“2015b); lack of access to psychotropic medicines and/or lack of sufficient training for rational prescribing practice (Patel et al. 2011; Agyapong et al. 2015a; Nimgaonkar & Menon, 2015); geographic and financial demand-side barriers to access of mental health services (Baker-Henningham et al.”
BackgroundMethodInfluentialTomlinson, M., Doherty, T., Jackson, D. J., Lawn, J. E., Ijumba, P., Colvin, M., Nkonki, L. L., Daviaud, E., Goga, A. E., Sanders, D. M., et al. (2011) · Trials · doi:10.1186/1745-6215-12-236 · Cited by 41 · cited 6× · see citing works
“It sometimes stems from physical, environmental, or sociocultural challenges and creates positive feedback loops that become difficult to break (Tomlinson et al. 2011; Thurman et al. 2014).”
BackgroundInfluentialAli, N. S., Ali, B. S., Azam, I. S., & Khuwaja, A. K. (2010) · BMC Psychiatry · doi:10.1186/1471-244x-10-57 · Cited by 36 · cited 8× · see citing works
“Thirteen papers were qualitative evaluations using surveys, interviews, focus groups, action research, implementation research, or case study methodology (Ali et al. 2010; Petersen et al. 2011; Thurman et al. 2014; Agyapong et al. 2015a, b, 2016; Larson-Stoa et al. 2015; Lorenzo et al. 2015; Magidson et al. 2015; Nimg…”
BackgroundMethodInfluentialIheanacho, T., Kapadia, D., Ezeanolue, C. O., Osuji, A., Ogidi, A. G., Ike, A., Patel, D. V., Stefanovics, E. A., Rosenheck, R. A., Obiefune, M. C., et al. (2015) · International Journal of Culture and Mental Health · doi:10.1080/17542863.2015.1074260 · Cited by 36 · cited 2× · see citing works
“Stigma, for instance, is an often-cited barrier in mental health seeking behaviours and even in provision of mental health care (van Ginneken et al. 2013; Nimgaonkar & Menon, 2015; Iheanacho et al. 2016; Weinmann & Koesters, 2016).”
BackgroundMagidson, J. F., Lejuez, C. W., Kamal, T., Blevins, E., Murray, L. K., Bass, J., Bolton, P. A., & Pagoto, S. (2015) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2015.22 · Cited by 31 · cited 14× · see citing works
“Thirteen papers were qualitative evaluations using surveys, interviews, focus groups, action research, implementation research, or case study methodology (Ali et al. 2010; Petersen et al. 2011; Thurman et al. 2014; Agyapong et al. 2015a, b, 2016; Larson-Stoa et al. 2015; Lorenzo et al. 2015; Magidson et al. 2015; Nimg…”
BackgroundMethodInfluentialAgyapong, V. I. O., Osei, A. O., McLoughlin, D. M., & McAuliffe, É. (2015) · Health Policy and Planning · doi:10.1093/heapol/czv114 · Cited by 30 · cited 17× · see citing works
“Across these different contexts, community mental health programmes were variable in nature with some being more integrated into existing health systems (Patel et al. 2010b, 2011; Petersen et al. 2011; Mendenhall et al. 2014; Agyapong et al. 2015a, b; Nimgaonkar & Menon, 2015; Agyapong et al. 2016; Wright & Chiwandira…”
BackgroundMethodInfluentialPradeep, J., Isaacs, A. N., Shanbag, D., Selvan, S., & Srinivasan, K. (2014) · Europe PMC (PubMed Central) · Cited by 29 · see citing works
Jotheeswaran, A. T., Dias, A., Philp, I., Beard, J., Patel, V., & Prince, M. J. (2015) · BMC Geriatrics · doi:10.1186/s12877-015-0121-1 · Cited by 28 · cited 1× · see citing works
“Some tools require the interpretation and training of health professionals to be appropriately and efficiently used, suggesting that not all technologies are readily transferable across health workforce cadres (Jotheeswaran et al. 2015; Robbins et al. 2015).”
BackgroundWright, J., & Chiwandira, C. (2016) · International Journal of Social Psychiatry · doi:10.1177/0020764016657112 · Cited by 28 · cited 4× · see citing works
“One study highlighted health promotion activities through working with community resources, such as schools and churches, as an enabling factor (Wright & Chiwandira, 2016).”
BackgroundMethodInfluentialPadilla, E., Molina, J. L., Kamis, D., Calvó, M., Stratton, L., Strejilevich, S., Alemán, G. G., Guerrero, G., Bourdieu, M., Conesa, H., et al. (2014) · Schizophrenia Research · doi:10.1016/j.schres.2014.10.039 · Cited by 24 · cited 13× · see citing works
“…SD, HRH, IT, MD, FS, LG, C Medicines shortages; demand-side financial barriers Decentralization of mental health services Education sector involved Padilla et al. (2015) SD, HRH, IT, FS, C Technology for screening; provincial system’s universal coverage mechanism Patel et al. (2010b) SD, HRH, IT,…”
BackgroundMethodInfluentialThurman, T. R., Kidman, R. C., & Taylor, T. M. (2014) · AIDS Care · doi:10.1080/09540121.2014.906555 · Cited by 23 · cited 9× · see citing works
“…using surveys, interviews, focus groups, action research, implementation research, or case study methodology (Ali et al. 2010; Petersen et al. 2011; Thurman et al. 2014; Agyapong et al. 2015a, b, 2016; Larson-Stoa et al. 2015; Lorenzo et al. 2015; Magidson et al. 2015; Nimgaonkar & Menon, 2015;…”
BackgroundMethodInfluentialBocoum, F. Y., Kouanda, S., Kouyaté, B., et al. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-997 · Cited by 22 · cited 7× · see citing works
“Buy-in and acceptance of task-shifting interventions across a wide range of stakeholders is also important in their success (Yaya Bocoum et al. 2013).”
BackgroundInfluentialA task shifting mental health program for an impoverished rural Indian community
Nimgaonkar, A. U., & Menon, S. D. (2015) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2015.05.044 · Cited by 21 · cited 15× · see citing works
“Some studies mentioned demandside financing as a barrier to improved mental health delivery, citing the ability to pay for basic mental health services from the patient’s perspective (Neuner et al. 2008; Nimgaonkar & Menon, 2015; Abas et al. 2016).”
BackgroundMethodInfluentialAgyapong, V. I. O., Osei, A., Farren, C. K., & Mcauliffe, E. (2015) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzv058 · Cited by 15 · cited 29× · see citing works
“Was an adequate sensitivity analysis performed? global mental health included although two of these reported on the same randomized controlled trial on MANAS in India (Patel et al. 2010b, 2011), and three were based on different perspectives of the community mental health programme in Ghana (Agyapong et al. 2015a, b,…”
BackgroundMethodInfluentialRichters, A., Rutayisire, T., & Slegh, H. (2013) · Culture Health & Sexuality · doi:10.1080/13691058.2013.780261 · Cited by 13 · cited 1× · see citing works
“By being community-based and having a deep understanding of community needs and assets, lay providers have an enhanced ability to identify social determinants of mental health within a given context (Richters et al. 2013; Padilla et al. 2015).”
BackgroundPaudel, S., Gilles, N., Hahn, S. A., Hexom, B. J., Premkumar, R., Arole, S., & Katz, C. L. (2013) · Community Mental Health Journal · doi:10.1007/s10597-013-9630-6 · Cited by 12 · cited 1× · see citing works
“This rich knowledge, combined with appropriate training, puts them in the optimal position to refer patients to relevant social services (Paudel et al. 2014).”
BackgroundLarson-Stoa, D., Jacobs, G. A., Jonathan, A., & Poudyal, B. (2018) · Torture Journal · doi:10.7146/torture.v25i2.109669 · Cited by 9 · cited 8× · see citing works
“Thirteen papers were qualitative evaluations using surveys, interviews, focus groups, action research, implementation research, or case study methodology (Ali et al. 2010; Petersen et al. 2011; Thurman et al. 2014; Agyapong et al. 2015a, b, 2016; Larson-Stoa et al. 2015; Lorenzo et al. 2015; Magidson et al. 2015; Nimg…”
BackgroundMethodInfluentialMental health services in low- and middle-income countries
Murthy, R. S. (2011) · Oxford Textbook of Community Mental Health · doi:10.1093/med/9780199565498.003.0177 · Cited by 8 · see citing works
Task shifting or power shedding?
van Niekerk, J. P. D. V. (2008) · PubMed · Cited by 6 · see citing works
Mental Health Services in Low- and Middle-Income Countries
Akour, A. A., Al‐Tammemi, A. B., Alrawashdeh, H. M., & Kakaje, A. (2023) · Springer eBooks · doi:10.1007/978-3-030-64477-2_46 · Cited by 1 · see citing works
Flagged first, then by citations
5 of the 74 references couldn’t be matched to a known paper.
Research works printed but not linked: 13
- 2007b, Joint WHO/OGAC Technical Consultation on Task Shifting: Key Elements of a Regulatory Framework in Support of In-country Implementation of Task Shifting
- 2007, Systems Support for Task-Shifting to Community Health Workers
- 2013, Joint Commitment to Harmonized Partners Action for Community Health Workers and Frontline Health Workers: Moving from Fragmentation to Synergy Toward Universal Health Coverage
- 1997, International Conference on Intersectoral Action for Health
- 2008, mhGAP Mental Health Gap Action Programme: Scaling Up Care for Mental, Neurological, and Substance Use Disorders
- 2008, Integrating mental health into primary care: a global perspective
- Levin, 2015, Disease Control Priorities 3: Mental, Neurological, and Substance Use Disorders, 1
- 2010, Monitoring the Building Blocks of the Health System
- 2009, Systems Thinking for Health Systems Strengthening
- 2009, Improving Health Systems and Services for Mental Health
- 2007a, Everybody's Business: Strengthening Health Systems to Improve Health Outcomes
- 2016, Critical Appraisal Skills Program: Making Sense of Evidence
- 2006, World Health Report 2006: Working Together for Health
Cited by
Sorted by citations
Firth, J., Siddiqi, N., Koyanagi, A., Siskind, D., Rosenbaum, S., Galletly, C., Allan, S., Caneo, C., Carney, R., Carvalho, A. F., et al. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30132-4 · Cited by 1,531 · see citing works
Future Directions in Single-Session Youth Mental Health Interventions
Schleider, J. L., Dobias, M. L., Sung, J. Y., & Mullarkey, M. C. (2020) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2019.1683852 · Cited by 335 · see citing works
Le, P. D., Eschliman, E. L., Grivel, M. M., Tang, J., Cho, Y. G., Yang, X., Tay, C., Li, T., Bass, J., & Yang, L. H. (2022) · Implementation Science · doi:10.1186/s13012-021-01179-z · Cited by 233 · see citing works
“Additionally, these and other reviews (for example, see [23]) have not been explicitly situated in an implementation science framework, limiting the applicability of the results to other task-sharing interventions, models, or settings.”
BackgroundMahmud, S. A. S., Hossain, S., Muyeed, A., Islam, M. M., & Mohsin, M. (2021) · Heliyon · doi:10.1016/j.heliyon.2021.e07393 · Cited by 216 · see citing works
Global mental health and COVID-19
Kola, L. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30235-2 · Cited by 181 · see citing works
Mahmud, S. A. S., Mohsin, M., Dewan, M. N., & Muyeed, A. (2022) · Trends in Psychology · doi:10.1007/s43076-021-00116-9 · Cited by 195 · see citing works
“These types of studies are inevitable for supporting public health globally and reducing the knowledge gap in the care of mental health disorders (Javadi et al., 2017).”
BackgroundEisman, A. B., Quanbeck, A., Bounthavong, M., Panattoni, L., & Glasgow, R. E. (2021) · Implementation Science · doi:10.1186/s13012-021-01143-x · Cited by 126 · see citing works
“This is sometimes achieved by the use of “task-shifting” in which delivery of an EBP is accomplished by much lower level—and thus lower cost—staff members such as community health workers or peer coaches [29].”
BackgroundPsychological First Aid Training: A Scoping Review of Its Application, Outcomes and Implementation
Wang, L., Norman, I. J., Xiao, T., Li, Y., & Leamy, M. C. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094594 · Cited by 126 · see citing works
“The discussion of this review on solutions is in line with global discussions about the need to task-shift at least a portion of mental health care to non-specialists [70,71], and the integration of Mental Health and Psychosocial Support (MHPSS) into disaster risk reduction efforts [72].”
BackgroundLi, J., Fan, Y., Zhong, H.-Q., Duan, X.-L., Chen, W., Evans-Lacko, S., & Thornicroft, G. (2019) · International Journal of Mental Health Systems · doi:10.1186/s13033-018-0259-2 · Cited by 98 · see citing works
Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV
Hoare, J., Sevenoaks, T., Mtukushe, B., Williams, T., Heany, S. J., & Phillips, N. J. (2021) · Current HIV/AIDS Reports · doi:10.1007/s11904-021-00583-w · Cited by 99 · see citing works
“Mental and physical health are interconnected, and early detection can lead to improved treatment outcomes and increase cost-effectiveness for the healthcare systems [170].”
BackgroundHeller, D. J., Kumar, A., Kishore, S. P., Horowitz, C. R., Joshi, R., & Vedanthan, R. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.16545 · Cited by 95 · see citing works
Mutahi, J., Larsen, A., Cuijpers, P. J., Peterson, S., Unützer, J., McKay, M. M., John-Stewart, G. C., Jewell, T. E., Kinuthia, J., Gohar, F., et al. (2022) · EClinicalMedicine · doi:10.1016/j.eclinm.2022.101289 · Cited by 90 · see citing works
Barriers and drivers to stakeholder engagement in global mental health projects
Murphy, J., Qureshi, O., Endale, T., Esponda, G. M., Pathare, S., Eaton, J., Silva, M. J. D., & Ryan, G. K. (2021) · International Journal of Mental Health Systems · doi:10.1186/s13033-021-00458-y · Cited by 81 · see citing works
Coronavirus disease 2019 (COVID-19) and global mental health
Lange, K. W. (2021) · Global Health Journal · doi:10.1016/j.glohj.2021.02.004 · Cited by 87 · see citing works
Cohodes, E. M., Kribakaran, S., Odriozola, P., Bakirci, S., McCauley, S., Hodges, H. R., Sisk, L. M., Zacharek, S. J., & Gee, D. G. (2021) · Developmental Psychobiology · doi:10.1002/dev.22158 · Cited by 72 · see citing works
“Task-sharing or task-shifting is one such model recommended by theWorld Health Organization that has been highly effective among migrant and refugee communities in low-, middle-, and high-income countries (Javadi et al., 2017; Thornicroft & Tansella, 2013; WHO, 2010).”
BackgroundFuture Directions in Lay Health Worker Involvement in Children’s Mental Health Services in the U.S.
Barnett, M. L., Sanchez, B. E. L., Rosas, Y. G., & Broder‐Fingert, S. (2021) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2021.1969655 · Cited by 70 · see citing works
“This example points to the necessity of moving beyond an intervention focused approach to a systems thinking approach when planning for the role of LHWs within children’s mental health services (Javadi et al., 2017).”
BackgroundAsrat, B., Schneider, M., Ambaw, F., & Lund, C. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.03.068 · Cited by 63 · see citing works
Kamvura, T. T., Dambi, J. M., Chiriseri, E., Turner, J., Verhey, R., & Chibanda, D. (2022) · BMC Nursing · doi:10.1186/s12912-022-00841-1 · Cited by 55 · see citing works
Lange, K. W. (2021) · Global Health Journal · doi:10.1016/j.glohj.2021.07.001 · Cited by 59 · see citing works
Mudiyanselage, K. W. W., De Santis, K. K., Jörg, F., Saleem, M., Stewart, R., Zeeb, H., & Busse, H. (2024) · BMC Public Health · doi:10.1186/s12889-023-17417-6 · Cited by 48 · see citing works
“Third, the types of intervention and control conditions differed regarding the use of digital technologies, the tasks of the non-specialists and the type of care [Additional file 6].”
BackgroundGreene, M. C., Kane, J. C., Khoshnood, K., Ventevogel, P., & Tol, W. A. (2018) · Harm Reduction Journal · doi:10.1186/s12954-018-0267-1 · Cited by 47 · see citing works
Appiah, B., Amponsah, I. K., Poudyal, A., et al. (2018) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-018-2334-2 · Cited by 46 · see citing works
“The WHO Health Systems Framework has been used to investigate universal health coverage [20], vertical programs [21], and integration of mental health services in primary care [22].”
MethodOkumu, M., Nyoni, T., & Byansi, W. (2021) · Global Public Health · doi:10.1080/17441692.2021.1912137 · Cited by 44 · see citing works
“psychosocial interventions that leverage cultural strategies) (Javadi et al., 2017; Mutamba et al., 2013; Patel et al., 2018; Singla et al., 2017; Ssewamala et al., 2018).”
Malterud, K., Aamland, A., & Fosse, A. (2020) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2020.1714143 · Cited by 42 · see citing works
“infectious diseases [2,21], mental health problems [22]”
Triliva, S., Ntani, S., Giovazolias, T., Kafetsios, K. G., Axelsson, M., Bockting, C., Buysse, A., Desmet, M., Dewaele, A., Hannon, D., et al. (2020) · International Journal of Mental Health Systems · doi:10.1186/s13033-020-00350-1 · Cited by 39 · see citing works
Chibanda, D., Abas, M., Musesengwa, R., Merritt, C., Sorsdahl, K. R., Mangezi, W. O., Bandawe, C., Cowan, F. M., Araya, R., Gomo, E., et al. (2020) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2019.32 · Cited by 33 · see citing works
“For instance, with the growing evidence of task-shifting approaches (Petersen et al., 2012; van Ginneken et al., 2013; Joshi et al., 2014; Nakimuli-Mpungu et al., 2015; Chibanda et al., 2016b; Javadi et al., 2017; Patel et al., 2017) AMARI could in the future contribute toward the development of culturally appropriate…”
BackgroundDistant mood monitoring for depressive and bipolar disorders: a systematic review
van der Watt, A. S. J., Odendaal, W., Louw, K.-A., & Seedat, S. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02782-y · Cited by 27 · see citing works
Donenberg, G. R., Cohen, M. H., Ingabire, C., Fabri, M. R., Emerson, E. M., Kendall, A. D., Remera, E., Manzi, O., & Nsanzimana, S. (2019) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000002204 · Cited by 31 · see citing works
Perera, C., McBride, K. A., Travers, Á., Blum, P. T., Wiedemann, N., Dinesen, C., Bitanihirwe, B. K. Y., & Vallières, F. (2021) · PLoS ONE · doi:10.1371/journal.pone.0256077 · Cited by 31 · see citing works
Bunn, M., Gonzalez, N., Falek, I., Weine, S. M., & Acri, M. C. (2021) · Intervention · doi:10.4103/intv.intv_47_20 · Cited by 29 · see citing works
“…traits, inter-personal skills and shared life experience, some of which were thought to facilitate greater integration, acceptability and trust with target populations (e.g. Huang et al., 2018; Javadi et al., 2017; Munodawafa et al., 2018; Padmanathan & De Silva, 2013; Verhey et al., 2020).”
BackgroundInfluentialJama, N. A., Nyembezi, A., Ngcobo, S., et al. (2024) · African Journal of Primary Health Care & Family Medicine · doi:10.4102/phcfm.v16i1.4430 · Cited by 29 · see citing works
“30,32,33,34 For collaboration to be reciprocal, it requires a process where THPs and BHPs form partnerships which, at the very least, constitute an act of client referral between two practitioners.”
BackgroundMahmud, S. A. S., Mohsin, M., Dewan, M. N., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-1136589/v1 · Cited by 29 · see citing works
Zhao, Y., Hagel, C., Tweheyo, R., Sirili, N. S., Gathara, D., & English, M. (2021) · Human Resources for Health · doi:10.1186/s12960-021-00637-5 · Cited by 24 · see citing works
“More recently it is embedded in care for non-communicable diseases [12], mental health [13] and children and adolescents with HIV/AIDS [14].”
BackgroundAre, A., Olisah, V., Bella-Awusah, T. T., & Ani, C. C. (2021) · International Journal of Mental Health · doi:10.1080/00207411.2021.1891361 · Cited by 23 · see citing works
“Tasksifting involves the use of non-mental health professionals to deliver mental health interventions (Javadi et al., 2017).”
BackgroundStrengthening mental health services in Sierra Leone: perspectives from within the health system
Fitts, J., Gegbe, F., Aber, M. S., Kaitibi, D. B., & Yokie, M. A. (2020) · Health Policy and Planning · doi:10.1093/heapol/czaa029 · Cited by 24 · see citing works
Future Directions in Single-Session Youth Mental Health InterventionsPreprint
Schleider, J. L., Dobias, M., Sung, J. Y., et al. (2019) · doi:10.31234/osf.io/m247u · Cited by 20 · see citing works
(Mis)Information and Anxiety: Evidence from a Randomized COVID-19 Information Campaign
Sadish, D., Adhvaryu, A. R., & Nyshadham, A. (2021) · Journal of Development Economics · doi:10.1016/j.jdeveco.2021.102699 · Cited by 19 · see citing works
“Phone calls designed specifically to task-shift mental health— provide mental health services through minimally trained persons— could be even more effective, consistent with existing evidence (Javadi et al., 2017; Kakuma et al., 2011).”
ResultMacDougall, A. G., Krupa, T. M., Lysaght, R. M., Mutiso, V., Casey, R., Ber, M. J. L., Ruhara, R. W., Price, E., Kidd, S. A., & Ndetei, D. M. (2021) · International Journal of Mental Health · doi:10.1080/00207411.2021.1926725 · Cited by 21 · see citing works
“…the role of the peer-facilitator in a communitybased mental health intervention, in keeping with the broader recommended strategy of task shifting for addressing human resource shortages and strengthening mental health systems in low resource settings (Javadi et al., 2017; Kohrt et al., 2018).”
BackgroundChibanda, D. (2018) · International Review of Psychiatry · doi:10.1080/09540261.2018.1564648 · Cited by 21 · see citing works
Validation of a brief screener for broad-spectrum mental and substance-use disorders in South Africa
Stockton, M. A., Mazinyo, E. W., Mlanjeni, L., Nogemane, K., Ngcelwane, N., Sweetland, A. C., Basaraba, C. N., Bezuidenhout, C., Sansbury, G. M., Lovero, K. L., et al. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.89 · Cited by 22 · see citing works
Nhemachena, T., Späth, C., Arendse, K. D., Lebelo, K., Zokufa, N., Cassidy, T., Whitehouse, K., Keene, C., & Swartz, A. (2023) · BMC Family Practice · doi:10.1186/s12875-022-01957-8 · Cited by 18 · see citing works
“Task-shifting in mental health has been found to be a feasible and effective strategy to rollout in resource-limited countries [34].”
Backgroundde Haan, M., van Eijk‐Hustings, Y., Bessems-Beks, M., et al. (2019) · Health Policy · doi:10.1016/j.healthpol.2019.07.003 · Cited by 18 · see citing works
Leyenaar, J. K., Arakelyan, M., Acquilano, S. C., Gilbert, T., Craig, J. T., Lee, C. N., Kodak, S. G., Ignatova, E., Mudge, L. A., House, S. A., et al. (2023) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2023.01.015 · Cited by 17 · see citing works
Filiatreau, L. M., Ebasone, P. V., Dzudié, A., Ajeh, R. A., Pence, B. W., Wainberg, M. L., Nash, D., Yotebieng, M., Anastos, K., Pefura-Yone, E. W., et al. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03306-y · Cited by 18 · see citing works
“To narrow the mental health treatment gap, mental health care task-sharing, or shifting service delivery tasks from health professionals with specialized training to individuals with less specialized, but task-specific training is being scaled-up in numerous settings [22, 23].”
BackgroundBelay, Y. B., Engel, L., Lee, Y. Y., Le, N., & Mihalopoulos, C. (2023) · PharmacoEconomics · doi:10.1007/s40273-023-01257-8 · Cited by 15 · see citing works
“One challenge to scale-up and implementation of task shifting is the lack of cost-effectiveness evidence to support decision making [57].”
BackgroundWoodward, A., Burchert, S., Barry, A. S., Broerse, J. E. W., Sondorp, E., Bold, A., Ruberl, A., Hessling, J. M., Knaevelsrud, C., Roberts, B., et al. (2023) · SSM - Mental Health · doi:10.1016/j.ssmmh.2023.100231 · Cited by 15 · see citing works
“Stigma associated with mental illness and seeking MHPSS support is a well-known barrier to scaling up (Esponda et al., 2020; Javadi et al., 2017; Liem et al., 2021; Petersen et al., 2019).”
BackgroundLange, B. C. L., Nelson, A. M., Lang, J. M., & Stirman, S. W. (2022) · Implementation Science Communications · doi:10.1186/s43058-022-00348-5 · Cited by 14 · see citing works
“This practice of task shifting is a common occurrence in the delivery of mental health services [75], and is particularly important as the need for mental health services outpaces the capacity of mental health professionals in many countries and communities.”
BackgroundSilaule, O., Casteleijn, D., Adams, F., & Nkosi, N. G. (2023) · Interactive Journal of Medical Research · doi:10.2196/48587 · Cited by 17 · see citing works
“…ensure sustainability, training of peer facilitators to deliver these interventions may be realistic as this aligns with a task-shifting approach, which has long been advocated for as a cost-effective strategy for increasing access to mental health services in low-and middle-income countries [101].”
BackgroundBuitrago, D. C. C., Rattner, M., James, L. E., & García, J. F. B. (2024) · Global Health Science and Practice · doi:10.9745/ghsp-d-23-00032 · Cited by 12 · see citing works
“22,54 62 – 64 As in many LMICs, the COVID-19 pandemic significantly impacted the accessibility of services in Colombia, and consequently, promotion of creative means to ensure equitable access, especially among vulnerable populations, is considered a critical component of ethical and feasible…”
BackgroundMethodInfluentialWoodward, A., Sondorp, E., Barry, A. S., Dieleman, M. A., Fuhr, D. C., Broerse, J. E. W., Akhtar, A., Awwad, M., Bawaneh, A., Bryant, R. A., et al. (2023) · Health Policy and Planning · doi:10.1093/heapol/czad003 · Cited by 12 · see citing works
“While the barriers are often at health system level, systems thinking to investigate scaling up is underutilized in tasksharing for mental health research (Javadi et al., 2017).”
BackgroundWoodward, A., de Graaff, A. M., Dieleman, M. A., Roberts, B., Fuhr, D. C., Broerse, J. E. W., Sijbrandij, M., Cuijpers, P. J., Ventevogel, P., Gerretsen, B., et al. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100171 · Cited by 11 · see citing works
McLean, C. P., Miller, M. L., Gengler, R., Henderson, J., & Sloan, D. M. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.105990 · Cited by 10 · see citing works
Mutyambizi-Mafunda, V., MYERS, B. J., Sorsdahl, K. R., Lund, C., Naledi, T., & Cleary, S. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026973 · Cited by 10 · see citing works
Galvin, M., & Michel, G. (2020) · Mental Health Religion & Culture · doi:10.1080/13674676.2020.1737921 · Cited by 10 · see citing works
“…India, Ghana, Zimbabwe, Pakistan, Malawi, South Africa, Uganda, Indonesia, Iraq, Argentina, Botswana Jamaica, Ethiopia, Zambia, and Thailand – found almost all studies displayed positive findings on mental health using task shifting and only one study showed no effect (Javadi et al., 2017).”
BackgroundInfluentialWoodward, A., Dieleman, M. A., Sondorp, E., Roberts, B., Fuhr, D. C., Ventevogel, P., Sijbrandij, M., & Broerse, J. E. W. (2021) · Intervention · doi:10.4103/intv.intv_29_20 · Cited by 10 · see citing works
hAnrachtaigh, É. Ó., Brown, G. P., Beck, A. F., Conway, R., Jones, H. G., & Angelakis, I. (2024) · Depression and Anxiety · doi:10.1155/2024/5037662 · Cited by 15 · see citing works
“It involves the delegation of speci fi c service delivery tasks from individuals with professional quali fi cations to non-specialist providers (NSPs) with no formal quali fi cations or training in mental health care provision [23].”
BackgroundIbrahim, M., Malik, M. R., & Noor, Z. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.4 · Cited by 9 · see citing works
“…Somalia could be an ingredient for success and overcome the systemic challenges often faced by LMIC countries in implementing task-shifting model (Javadi et al., 2017) COVID-19 and its mental health consequences A worldwide global survey undertaken by WHO looking into the impact of COVID on…”
BackgroundTsai, L. C., Carlson, C., Baylosis, R., Hentschel, E., Nicholson, T., Eleccion, J., Ubaldo, J., Stanley, B., Brown, G. K., & Wainberg, M. L. (2021) · Qualitative Health Research · doi:10.1177/10497323211062858 · Cited by 9 · see citing works
“One approach to delivering mental healthcare in lowresource contexts with growing evidence is task-shifting or task-sharing, a strategy in which non-mental health professionals are trained in evidence-based mental health interventions (Hoeft et al., 2018; Javadi et al., 2017).”
BackgroundTrang, D. T. H., Ha, B. T. T., Vui, L. T., Chi, N. T. Q., Le, T. M., Duong, D. T. T., Hung, D. T., de Chavez, A. C., Manzano, A., Lakin, K., et al. (2024) · Health Policy and Planning · doi:10.1093/heapol/czae027 · Cited by 14 · see citing works
“Moreover, mental and physical health are interconnected and, as such, the integration should require a move beyond a health system (Javadi et al ., 2017).”
BackgroundSchwartz, A., Davern, N., Herer, A., Urquilla, M. P., Corey, J., Muthuramalingam, D., & Vallabhaneni, N. (2025) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.70014 · Cited by 8 · see citing works
Knowledge gaps in implementing global mental health activities
Saxena, S., & Belkin, G. (2017) · Global Mental Health · doi:10.1017/gmh.2017.20 · Cited by 9 · see citing works
“The paper by Javadi et al. (2017) provides a critical review of the current literature on task-sharing for mental health.”
BackgroundThobane, K. F., Mulaudzi, F. M., Lavhelani, N. R., & Gundo, R. (2024) · International Journal of Africa Nursing Sciences · doi:10.1016/j.ijans.2024.100761 · Cited by 8 · see citing works
Constructing a Nurse-led Cardiovascular Disease Intervention in Rural Ghana: A Qualitative Analysis
Wood, E. P., Garvey, K. L., Aborigo, R., Dambayi, E., Awuni, D., Squires, A. P., Jackson, E. F., Phillips, J. F., Oduro, A. R., & Heller, D. J. (2021) · Annals of Global Health · doi:10.5334/aogh.3379 · Cited by 7 · see citing works
A simulation–optimization framework for post-disaster allocation of mental health resources
Cunningham, S. L., Schuldt, S., Chini, C. M., & Delorit, J. D. (2021) · Natural hazards and earth system sciences · doi:10.5194/nhess-21-3843-2021 · Cited by 7 · see citing works
Johnson, L. C. M., Thompson, N. J., Ali, M. K., Elifson, K. W., Chwastiak, L., Mohan, V., Anjana, R. M., Poongothai, S., & Tandon, N. (2022) · American Journal of Medicine Open · doi:10.1016/j.ajmo.2022.100015 · Cited by 7 · see citing works
Friends’ Perspective: Young Adults’ Reaction to Disclosure of Chronic Illness
Igler, E. C., Austin, J. E., Sejkora, E. K. D., & Davies, W. H. (2023) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-023-09956-2 · Cited by 6 · see citing works
“Further, there is growing support for use of hospital support staff or “lay healthcare workers” who receive training and supervision regarding specific psychological interventions for common mental health disorders (Javadi et al., 2017; Shahmalak et al., 2019).”
Ohta, R., Yawata, M., & Sano, C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19169944 · Cited by 7 · see citing works
“As present medical systems are complicated, medical professionals may be overwhelmed by clerical work, losing their identity and motivation [9,40].”
BackgroundYang, L. H., Bass, J. K., Le, P. D., Singh, R., Gurung, D., Velasco, P. R., Grivel, M. M., Susser, E., Cleland, C. M., Alvarado, R., et al. (2024) · BMC Health Services Research · doi:10.1186/s12913-024-11783-6 · Cited by 4 · see citing works
Lakin, D. P., Murray, S. M., Lasater, M. E., Kaysen, D., Mataboro, A., Annan, J., Bolton, P., & Bass, J. K. (2022) · Journal of Traumatic Stress · doi:10.1002/jts.22734 · Cited by 6 · see citing works
She, X., Tong, L., Wang, H., Lan, L., Wang, M., Abbey, C., Singh, M. K., & Rozelle, S. (2023) · JAACAP Open · doi:10.1016/j.jaacop.2023.08.004 · Cited by 5 · see citing works
“58 A recent review in pediatric mental health highlighted the limited evidence in LMICs, most of which supports positive youth development programs, but other interventions such as school-based mental health promotion, peer outreach, and digital interventions should be further explored.”
Universal mental health training for frontline professionals: evaluation of pilot trial in Ukraine
Горбунова, В., Klymchuk, V., Портницька, Н. Ф., Savychenko, О., Тичина, І. М., & Steffgen, G. (2024) · Open Research Europe · doi:10.12688/openreseurope.16941.2 · Cited by 12 · see citing works
“The task-shifting results in decreasing stigma, strengthening referral pathways and increasing universal health coverage with a focus on equity of service provision (Javadi et al ., 2017; McInnis & Merajver, 2011; Scantlebury et al ., 2018).”
Clergy-Provided Mental Health Services
Hooley, C., Wang, Y., & Hodge, D. R. (2021) · Advances in Social Work · doi:10.18060/23975 · Cited by 6 · see citing works
“Systematic reviews of behavioral health task-shifting have found the strategy to be both feasible and effective, resulting in improved behavioral health outcomes (Deimling Johns et al., 2018; Grant et al., 2018; Javadi et al., 2017).”
BackgroundBarriers and Drivers to Stakeholder Engagement in Global Mental Health ProjectsPreprint
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“At the system level, collaboration among key local actors, public sector partnerships and the use of monitoring tools are vital for effective implementation and sustained success [45, 46].”
Can anonymisation become disempowering? Rethinking ethics for low-risk global health research
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“TS /S reallocate responsibilities among existing providers to tackle workforce shortfalls and have been used across domains [ 6 ], including filling mental health care gaps in LMICs [ 7 ].”
James, L. E., Mejía, N. G., García, J. F. B., & Rattner, M. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.50 · Cited by 3 · see citing works
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Jayawickreme, N., Jayawickreme, E., McCaffrey, A. Z., & Thiruvarangan, M. (2025) · SSM - Mental Health · doi:10.1016/j.ssmmh.2025.100465 · Cited by 5 · see citing works
Consumer and Family Perspectives to Achieve Mental Health Equity
McCray, C. I. (2020) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2020.06.003 · Cited by 3 · see citing works
Integrated mental health screening for obstetric fistula patients in Mali: From evidence to policy
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Psychological Governance and COVID-19: A Case Study in Macropsychology
McVeigh, J., & MacLachlan, M. (2021) · Springer eBooks · doi:10.1007/978-3-030-50176-1_14 · Cited by 2 · see citing works
A Comparative Effectiveness Trial of Depression Collaborative Care: Subanalysis of Comorbid Anxiety
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Looking at Global Mental Health Models to Prevent Youth Suicide in the United States
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“…makers to service planners and managers, non-governmental organizations, service providers, traditional and spiritual leaders, and representatives of other community organisations will optimise the success of implementing interventions in wider contexts (Davies and Lund, 2017; Javadi et al., 2017).”
Yang, L. H., Bass, J. K., Le, P. D., Singh, R., Gurung, D., Velasco, P. R., Grivel, M. M., Susser, E., Cleland, C. M., Alvarado, R., et al. (2024) · Research Square · doi:10.21203/rs.3.rs-3877031/v1 · Cited by 2 · see citing works
New Frontiers in Mental Health
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Mental Health: The Need for Effective Policies
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“Recent calls have been made to address mental health service gaps by recognizing the potential of nonprofessionals to effectively deliver mental health interventions (Byers et al., 2023; Javadi et al., 2017; Kazdin, 2019).”
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Global and Socioeconomic Considerations in the Delivery of PE: The Role of Task Shifting
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“…the WHO-endorsed task-shifting approach as a partial delegation of some mental health support tasks to trained non-mental health service providers (Javadi et al. , 2017), the UMHT equips frontline workers with basic skills to recognize when someone is experiencing a mental health issue, provides…”
Ulysses Syndrome and the COVID-19 Pandemic
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- Authors
- Javadi, D., Feldhaus, I., Mancuso, A., & Ghaffar, A.
- Affiliations
- World Health Organization (CH)
- Harvard University (US)
- Johns Hopkins University (US)
- Corresponding author
- Javadi, D.
- Venue
- Global Mental Health
- Publisher
- Cambridge University Press (CUP)
- Published
- 2017
- Volume
- 4
- Pages
- e14-e14
- ISSN
- 2054-4251 (ISSN-L)
- PMC
- PMC5719475
- OpenAlex
- W2739628147
- Cited by
- 144
- References
- 74
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 29 · 2023: 24 · 2022: 10 · 2021: 36 · 2020: 12 · 2019: 8 · 2018: 4 · 2017: 1
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Cambridge Prisms Global Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- World Health Organization
- University of Cambridge
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- task shifting, systems thinking, lay providers, community mental health system, mental health service delivery, low- and middle-income countries, systems strengthening, healthcare workers, stakeholder perspectives, unintended consequences, community building
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