Enabling mental health task-sharing

Enabling mental health task-sharing healthcareservices.vision


Background: There is a shortage of the human resources needed to deliver mental health services which are likely to be exacerbated by COVID-19.

Due to mental health workforce shortages, task-shifting and task-sharing approaches have been implemented in several countries.

Clinical associates, a mid-level cadre working under the supervision of medical practitioners, could play a role in delivering mental health services but it is not clear if they are adequately prepared.

This study explored the mental health curriculum content of the undergraduate clinical associate training programs in South Africa and the views of key informants on the adequacy of training in mental health.

Methods: A qualitative collective case study approach was utilized for this multisite study at the three universities in South Africa offering clinical associate degrees.

The study consisted of in-depth interviews utilizing videoconferencing of individuals involved in each program and a document review. Thematic analysis of the data was conducted.

Results: Nineteen interviews were conducted. Mental health formed part of the curriculum in all three programs with the bulk of the training taking place in the final year of the three-year degree.

Facility-based training ranged from two weeks to four weeks with one university only using hospitals with mental health units while two universities used hospitals at which the students were based for the year regardless of potential mental health exposure they would receive.

The list of curricula inclusions extended to seldom-seen conditions. The quality of training and supervision appeared site-dependant and only one university set minimum experiential targets.

Conclusion: There is a basis on which to build the competencies and skills regarding mental health in this cadre. A training model that integrates mental health early in the undergraduate curriculum, focuses on common conditions and those with high disease burden, includes time in a mental health unit, provides facility-based trainers with detailed guidance to improve standardization, and includes specific experiential targets that are monitored will enhance the potential utility of this cadre.



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