Addictions Research Group, Sangath, Porvorim, Goa, 403501, India.
Harvard University, Cambridge, MA, USA.
Adm Policy Ment Health. 2021 Jul;48(4):695-706. doi: 10.1007/s10488-020-01102-6. Epub 2021 Jan 16.
A significant treatment gap exists for mental illnesses across the world, particularly in low- and middle-income countries (LMICs). Task-sharing, a potentially scalable strategy to bridge the treatment gap, has been shown to be feasible and effective for the treatment of a range of mental illnesses. However, there is a lack of research examining lay mental health workers' experiences in such task-sharing roles. The aim of our study was to understand the barriers and facilitators that lay health workers (LHWs) face in delivering mental healthcare. We conducted in-depth interviews with 32 lay mental health workers recruited through maximum variation sampling and 18 stakeholders leading mental health programs at a variety of non-governmental organisations across India. Interviews were semi-structured and data was analyzed using the thematic analysis approach. Results showed that LHWs perceived barriers and facilitators at three levels: individually (related to personal characteristics and family support, and in their daily work such as in relationship building and supervision), organizationally (for example, related to compensation), and societally (such as encountering gender discrimination and stigma). Each of these areas should be taken into consideration when planning and implementing task-sharing interventions for mental illnesses. As the first qualitative study to explore broad LHW experiences in mental healthcare delivery in a diverse set of programs from a LMIC, this study shows that LHW voices should be central to program design and decision-making for mental health interventions.
在全球范围内，特别是在中低收入国家（LMICs），精神疾病的治疗差距很大。任务分担是一种潜在的可扩展策略，可以弥合治疗差距，已被证明对治疗一系列精神疾病是可行且有效的。然而，对于研究非专业精神卫生工作者在这种任务分担角色中的经验，研究还很缺乏。我们的研究旨在了解非专业卫生工作者（LHWs）在提供精神卫生保健方面面临的障碍和促进因素。我们通过最大变异抽样招募了 32 名非专业精神卫生工作者进行深入访谈，并采访了在印度各地的各种非政府组织中领导精神卫生项目的 18 名利益相关者。访谈采用半结构化的方式进行，数据采用主题分析方法进行分析。结果表明，LHWs 在三个层面上感知到障碍和促进因素：个人层面（与个人特征和家庭支持有关，以及在日常工作中，如建立关系和监督）、组织层面（例如，与薪酬有关）和社会层面（如遇到性别歧视和耻辱）。在规划和实施精神疾病的任务分担干预措施时，应该考虑到这些方面。作为第一项从 LMIC 的不同项目中探索非专业精神卫生工作者在广泛的精神卫生保健服务提供方面的经验的定性研究，本研究表明，非专业精神卫生工作者的声音应该成为精神卫生干预措施的方案设计和决策的核心。
