Core skills associated with mental health intervention in community-based rehabilitation: A Realist Review

Authors: Lauren Deimling Johns, Mac MacLachlan, Jessica O’Dowd Background There is a global need to provide human resources for health in Low and Middle Income Countries (LMICs). Task-shifting has been implemented in... [ view full abstract ]

Authors: Lauren Deimling Johns, Mac MacLachlan, Jessica O’Dowd

Background
There is a global need to provide human resources for health in Low and Middle Income Countries (LMICs). Task-shifting has been implemented in Community-based rehabilitation (CBR) settings distributing skills and responsibilities subsequently increasing accessibility to care. Although CBR began as a specialized service for individuals struggling with musculoskeletal challenges it has now expanded into a primary healthcare system in LMICs, which, in some cases, now includes mental health identification and management. This research aimed to investigate what skills are required for CBR workers relating to mental health and how different settings affect how these programmes work.

Method
A realist review format was taken which (i) identified what skills were being used by CBR workers to attend to mental health, (ii) explored the effectiveness of CBR workers for mental health interventions and (iii) consolidated information regarding setting influencing outcome. This was completed through a ‘cochrane-style’ systematic search of the literature. Eleven databases were searched for specific terms relating to mental health, worker skills, CBR, and LMIC. A further search of grey literature was completed. To be included the studies needed to relate to programs where CBR workers engaged with mental health programs.

Results:
Twenty-eight pieces of literature were identified fitting criteria (RCT, qualitative, editorial, etc.). (i)The most frequently identified skills used by CBR workers included; counseling (including bereavement), mental health literacy, enhancement of social networks, health promotion, appropriate referral and response, supporting the family, crisis intervention and advocacy. Skills identified regarding delivery included; openness, listening (including active), effective and clear communication (including verbalization) and non-judgmental attitude. (ii) In the literature overall, the use of task shifting appears an effective and viable option for increasing human resource for mental health intervention, allowing more patients to receive treatment. (iii) Factors which affect how programs work included; stigma, empowerment, accessibility, trust, collaboration, culture, engagement with local leaders, state of crisis, training paralleling treatment and illiteracy.

Conclusion:
Core skills relating to mental health in CBR have been identified along with contexts and mechanisms which affect how programs may work. In identifying what skills CBR workers are currently using in differing contexts with unique outcomes we can more appropriately gauge what tasks can be effectively shifted to workers in diverse CBR settings. This moves towards the facilitation of accessible, empirically supported mental health intervention in the current human resource for health crisis.