How competent are non-specialists trained to integrate mental health services in primary care? Global health perspectives from Uganda, Liberia, and Nepal

Abstract

Evaluations to objectively assess minimum competency are not routinely implemented for training and supervision in global mental health. Addressing this gap in competency assessment is crucial for safe and effective mental health service integration in primary care. To explore competency, this study describes a training and supervision program for 206 health workers in Uganda, Liberia, and Nepal in humanitarian settings impacted by political violence, Ebola, and natural disasters. Health workers were trained in the World Health Organization’s mental health Gap Action Programme (mhGAP). Health workers demonstrated changes in knowledge (mhGAP knowledge, effect size, d = 1.14), stigma (Mental Illness: Clinicians’ Attitudes, d = −0.64; Social Distance Scale, d = −0.31), and competence (ENhancing Assessment of Common Therapeutic factors, ENACT, d = 1.68). However, health workers were only competent in 65% of skills. Although the majority were competent in communication skills and empathy, they were not competent in assessing physical and mental health, addressing confidentiality, involving family members in care, and assessing suicide risk. Higher competency was associated with lower stigma (social distance), but competency was not associated with knowledge. To promote competency, this study recommends (1) structured role-plays as a standard evaluation practice; (2) standardized reporting of competency, knowledge, attitudes, and clinical outcomes; and (3) shifting the field toward competency-based approaches to training and supervision.

Keywords:

• Depression
• developing countries
• non-specialists
• primary care
• psychosis
• stigma
• schizophrenia

Acknowledgements

The authors thank the members of the mental health Beyond Facilities research team and partner organizations: Aida Namubiru, Kisa Rose, Sheila Kangere, Rehema Kajungu, Musazi Miriam, Dr. Fred Kigozi, Reverend Bill Jallah, Sidney Flomo, Suraj Koirala, Mangesh Angdembe, Damodar Rimal, Salita Gurung, Sudip Ghimire, Chetkant Bhusal, and Shanti Pandit. This work is dedicated to the memories of Dr. Sheila Ndyanabangi and Nir Prakash Giri.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

This project was funded by a grant from Grand Challenges Canada to Makerere University School of Public Health (FB, Principal Investigator), Grant #GMH_0091-04: mental health Beyond Facilities, mhBeF. BAK receives funding from the U.S. National Institute of Mental Health [K01MH104310].