Systematic review of task-sharing mental health care in low- and middle-income countries: With whom is the task shared?

Background: Task-sharing in mental health care involves the training of non-specialist health workers and community members to deliver mental health services. With the need for mental health services in many low- and middle-income countries (LMICs) continuing to exceed the delivery capabilities within those countries, attention increasingly turns to task-sharing as a way to expand mental health care provision. Task-sharing programs vary widely regarding the trainees involved; consequently, a description of trainees and how they are selected across programs would inform further task-sharing research and implementation. 

Methods: A literature search for mental health task-sharing training in LMICs revealed over 1,000 publications in peer-reviewed journals, of which 122 publications describing 129 unique training programs met inclusion criteria for the review. The training programs were coded for trainee profession, trainee selection criteria, and trainee compensation.

Results: Training programs most commonly involved trainees who were laypeople (21%), followed by primary care workers (19%), community health workers (13%), and teachers (7%). It was also common for programs to involve multiple types of trainees (15%). Many studies did not describe how trainees were selected (53%). Among those that did, selection was often based on simple criteria (19%) or organizational nomination (12%); testing was infrequently used (4%). Studies rarely contained information regarding if and how trainees were compensated (77%).

Conclusion: This review describes the wide range of approaches to selecting trainees for task-sharing programs and highlights gaps in reporting that should be addressed in order to better inform future task-sharing research and policies.