Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.
VA Puget Sound Health Care System, Seattle, Washington.
J Rural Health. 2018 Dec;34(1):48-62. doi: 10.1111/jrh.12229. Epub 2017 Jan 13.
Rural areas persistently face a shortage of mental health specialists. Task shifting, or task sharing, is an approach in global mental health that may help address unmet mental health needs in rural and other low-resource areas. This review focuses on task-shifting approaches and highlights future directions for research in this area.
Systematic review on task sharing of mental health care in rural areas of high-income countries included: (1) PubMed, (2) gray literature for innovations not yet published in peer-reviewed journals, and (3) outreach to experts for additional articles. We included English language articles published before August 31, 2013, on interventions sharing mental health care tasks across a team in rural settings. We excluded literature: (1) from low- and middle-income countries, (2) involving direct transfer of care to another provider, and (3) describing clinical guidelines and shared decision-making tools.
The review identified approaches to task sharing focused mainly on community health workers and primary care providers. Technology was identified as a way to leverage mental health specialists to support care across settings both within primary care and out in the community. The review also highlighted how provider education, supervision, and partnerships with local communities can support task sharing. Challenges, such as confidentiality, are often not addressed in the literature.
Approaches to task sharing may improve reach and effectiveness of mental health care in rural and other low-resource settings, though important questions remain. We recommend promising research directions to address these questions.
农村地区一直面临着心理健康专家短缺的问题。任务转移或任务分担是全球心理健康领域的一种方法，可能有助于解决农村和其他资源匮乏地区未满足的心理健康需求。本综述重点介绍了任务分担方法，并为该领域的未来研究指明了方向。
对高收入国家农村地区精神卫生保健任务分担的系统评价包括：（1）PubMed；（2）尚未在同行评议期刊上发表的创新型灰色文献；（3）向专家征求其他文章。我们纳入了 2013 年 8 月 31 日之前发表的英文文章，内容涉及在农村环境中通过团队分担精神卫生保健任务的干预措施。我们排除了以下文献：（1）来自中低收入国家的文献；（2）涉及将护理直接转交给其他提供者的文献；（3）描述临床指南和共同决策工具的文献。
该综述确定了主要集中在社区卫生工作者和初级保健提供者的任务分担方法。该综述还强调了如何通过技术利用心理健康专家来支持在初级保健和社区内的各种环境中的护理。该综述还突出了提供者教育、监督以及与当地社区的伙伴关系如何支持任务分担。在文献中，通常没有解决保密性等挑战。
任务分担方法可能会提高农村和其他资源匮乏地区精神卫生保健的可及性和效果，但仍存在一些重要问题。我们建议有前途的研究方向来解决这些问题。
