Services Flashcards
What is task-shifting?
When circumscribed components of care are delegated to existing or new cadres of worker who either have less training OR more narrowly focused training than specialists
What is task-sharing?
When task-shifting is done with ongoing support and input from specialist mental health care
What is the predominant benefit of task-sharing?
Addressing the treatment gap
- between need for mh care in community and availability of care
What is the treatment gap for people with severe mental disorders in many low-income countries?
Treatment gap of 90%
- fewer than 10% receive evidence-based treatment
Why should specialist mental health care be shared with generalist health workers?
- Generalist health workers are much more numerous than specialists
AND they’re located in more accessible health facilities - there will never be enough specialists to meet the need of the community
What are four potential benefits of task-sharing?
- Increase access to care
- Cheaper and more efficient use of human resources
- More acceptable care
- Integrate both mental and physical health services
How would task-sharing result in more acceptable care?
Trained primary healthcare workers will keep people closer to their existing supports and social world
What is the limit of the evidence base of the mhGAP intervention guide treatments?
The evidence base is for the clinical guidelines
NOT for effectiveness of task-sharing service model
Who can be the targets of mental health task-sharing?
- Generalist health worker
- Community members
- Family members
- Peers
- Traditional and religious healers
What are the general findings of the systematic review of Van Ginneken et al. (2013) on the task-sharing model of care?
> Low quality of evidence on task-sharing
- especially for service interventions (mhGAP, collaborative care models)
- limited evidence of symptom reduction for PTSD
- small effects on outcomes for dementia
- good quality evidence for reduced symptom severity in maternal depression
> Absence of evidence for severe mental disorders (e.g. psychosis)
Why may psychosis most benefit from task-shared care?
In psychosis:
- high level of disability and vulnerability to human rights violations
What are the reasons for the lack of research into task-sharing models for people with severe mental disorders?
Severe mental disorders:
- Need for clinical assessment (diagnosis, symptoms)
- Increased cost of the study (screening scale administered by lay interviewer)
- Scarcity of clinical researchers
- Controversy on patient’s capacity to consent (to treatment of participation to study)
- Stigmatising attitudes
What are the two main challenges with task-sharing?
Acceptability and feasibility
What did Padmanathan and De Silva (2013) find about the acceptability and feasibility of task-sharing for mental healthcare in LMICs?
- Task-sharing welcomed but not seen as easy fix
- Service users appreciated interventions but reported unmet needs
perhaps from narrow focus of interventions
Which challenges could there be with task-sharing (besides acceptability and feasibility)?
- Emotional burden on providers who have little support
- Lack of confidence in skills
- Need for ongoing supervision
- Need for incentivisation
- Limited resources
- Neglect of ongoing specialist support (because it’s expensive)
- Quality of care (with only short-term training for low-level PHWs)
- Fidelity to original intervention (task-shared cared that respects evidence-based version of therapy)
- Sustainability (ongoing enthusiasm depict routine practice)
- System barriers (e.g. staff turnover, medication supply, weak leadership, …)
