How competent are non-specialists trained to integrate mental health services in primary care? Global health perspectives from Uganda, Liberia, and Nepal

Kohrt, Brandon A.; Mutamba, Byamah B.; Luitel, Nagendra P.; Gwaikolo, Wilfred; Onyango Mangen, Patrick; Nakku, Juliet; Rose, Kisa; Cooper, Janice; Jordans, Mark J.D.; Baingana, Florence

doi:10.1080/09540261.2019.1566116

Cited by 83Innovations in Medical EducationMental Health Treatment and AccessCompetency Development and Evaluation

How competent are non-specialists trained to integrate mental health services in primary care? Global health perspectives from Uganda, Liberia, and Nepal

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Kohrt, Brandon A., Mutamba, Byamah B., Luitel, Nagendra P., Gwaikolo, Wilfred, Onyango Mangen, Patrick, Nakku, Juliet, Rose, Kisa, Cooper, Janice +2 more·2018·International Review of Psychiatry

DOI 10.1080/09540261.2019.1566116PMC PMC6499679

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Abstract

Evaluations to objectively assess minimum competency are not routinely implemented for training and supervision in global mental health. Addressing this gap in competency assessment is crucial for safe and effective mental health service integration in primary care. To explore competency, this study describes a training and supervision program for 206 health workers in Uganda, Liberia, and Nepal in humanitarian settings impacted by political violence, Ebola, and natural disasters. Health workers were trained in the World Health Organization's mental health Gap Action Programme (mhGAP). Health workers demonstrated changes in knowledge (mhGAP knowledge, effect size, d = 1.14), stigma (Mental Illness: Clinicians' Attitudes, d = -0.64; Social Distance Scale, d = -0.31), and competence (ENhancing Assessment of Common Therapeutic factors, ENACT, d = 1.68). However, health workers were only competent in 65% of skills. Although the majority were competent in communication skills and empathy, they were not competent in assessing physical and mental health, addressing confidentiality, involving family members in care, and assessing suicide risk. Higher competency was associated with lower stigma (social distance), but competency was not associated with knowledge. To promote competency, this study recommends (1) structured role-plays as a standard evaluation practice; (2) standardized reporting of competency, knowledge, attitudes, and clinical outcomes; and (3) shifting the field toward competency-based approaches to training and supervision.

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The ENACT tool was created to assess mental health and psychosocial support skills through role plays, for both specialist and non-specialist providers, across different cultures, contexts, and intervention types.
“EQUIP will encompass a competency evaluation tool, the Enhancing Assessment of Common Therapeutic Factors (ENACT), that has been developed for role-play based assessment of mental health and psychosocial support skills for non-specialist and specialist providers across cultures, context and types of interventions 8,9 .”
From Ensuring Quality in Psychological Support (WHO EQUIP): developing a competent global workforce (2020) · cites this paper as [9]

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Authors: Kohrt, B. A., Mutamba, B. B., Luitel, N. P., Gwaikolo, W., Onyango Mangen, P., Nakku, J., Rose, K., Cooper, J., Jordans, M. J. D., & Baingana, F.
Affiliations: George Washington University (US)
Butabika Hospital (UG)
Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal;
The Carter Center Mental Health Program, Monrovia, Liberia;
Transcultural Psychosocial Organization Uganda, Kampala, Uganda;
Makerere University School of Public Health, Kampala, Uganda;
King's College London (GB)
Makerere University (UG)
Corresponding author: Kohrt, Brandon A.
ORCID: Kohrt, Brandon A.
Mutamba, Byamah B.
Luitel, Nagendra P.
Gwaikolo, Wilfred
Nakku, Juliet
Cooper, Janice
Jordans, Mark J.D.
Baingana, Florence
Venue: International Review of Psychiatry
Publisher: Informa UK Limited
Published: 2018-11-02
Volume: 30
Issue: 6
Pages: 182-198
ISSN: 0954-0261 (ISSN-L)
1369-1627
DOI: 10.1080/09540261.2019.1566116
PMC: PMC6499679
OpenAlex: W2915488841
Cited by: 83
References: 42
Citations by year: 2026: 7 · 2025: 6 · 2024: 13 · 2023: 7 · 2022: 22 · 2021: 21 · 2020: 5 · 2019: 2
FWCI: 6.67
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: International Review of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Figshare (submittedVersion, cc-by)
Research Portal (King's College London) (submittedVersion)
Figshare (cc-by)
Funders: Makerere University School of Public Health (#GMH_, -04)
U.S. National Institute of Mental Health (10)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Social Psychology › Competency Development and Evaluation
Keywords: mental health integration, primary care, competency assessment, non-specialist mental health workers, Mental Health Gap Action Programme, training and supervision, stigma, social distance, humanitarian settings, political violence, Ebola, natural disasters, competency-based training, role play, suicide risk assessment, confidentiality, Uganda, Liberia, Nepal
MeSH terms: Adult, Mental Disorders, Clinical Competence, Community Mental Health Services, Developing Countries, Female, Health Personnel, Humans, Health Knowledge, Attitudes, Practice, Liberia, Male, Nepal, Primary Health Care, Uganda, Global Health

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How competent are non-specialists trained to integrate mental health services in primary care? Global health perspectives from Uganda, Liberia, and Nepal

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