Task shifting in community mental health services

Introduction:
One of the cornerstones of primary health-care reforms advocated by the World Health Organization
(WHO) in the 2008 World Health Report is achieving universal health coverage and reducing health
inequalities. However, the critical shortages in human resources for health, particularly mental
health professionals, constitute one of the key barriers for accessing quality health care, resulting in
significant unmet mental health-care needs among populations. Thus, task shifting is needed as a
low-cost solution to tackling gaps in health services in the developing world, for example those in
HIV and mental health treatment.
Content:
Definition: "the rational redistribution of tasks among health workforce teams" in which "specific
tasks are moved, where appropriate, from highly qualified health workers to health workers with
shorter training and fewer qualifications". (WHO 2008)
The program was added to a pre-existing medical program and utilized community workers to
improve health care delivery. Health workers (occupational therapist, social health worker,
counsellor, health volunteers) were trained to provide community education and to identify and
refer individuals with psychiatric problems to a community hospital.
The tasks to be shifted/shared :
1. Identifying new cases in communities
2. Trace defaulting patients and relink to CPNs (community psyciatric nurses), Psychologists
3. Give psychoeducation talks within community, in schools, and on radio and TV (on issues
such as mental illness, drug abuse, teenage pregnancy, sexual abuse, etc.)
4. Collect data in the communities, with regard to how culture, customs, and behaviours affect
the way mental health is viewed
5. Maintain a proper record of information on the
a. prevalence of mental illness within the community and
b. health needs of people with mental illness in the community
6. Follow up of the psychiatric patients to improve treatment adherence.

Task Confusion
1. Lack of clarity of their job description and title
2. Hospitals not informed resulting in personnel being tasked with organizing and maintaining
patient records in the file office.
3. Lacked useful experience in dealing with patients and translating theory to practice.

Challenges experienced
1. little to no logistical support.
a. Personnel often paid for their own transportation to and from clients home and
community health talks.
b. dealing with aggressive and violent clients,
c. lack of privacy in the mental health unit,
d. language barriers (translation required when working with clients).
2. Lack of supervision on the job and lack of hierarchical structure
3. local communities were initially resistant to work of the personnel since their core beliefs
were in spiritual causes of illness
4. stigma against people with mental illness

Preparation:
1. Orientation
2. Manual preparation
a. stepwise guide to psychoeducation, establishing rapport, limits to job description,
first aid and safety consideration, ethics. Etc
3. Provision of visual aids, flipcharts, and printed materials for community psycho education.

Conclusion:
Task shifting offers high-quality, cost-effective care to more patients than a physician-centered
model. The main challenges to implementation include adequate and sustainable training, support
and pay for staff in new roles, the integration of new members into healthcare teams, and the
compliance of regulatory bodies. Task shifting should be considered for careful implementation
where HRH shortages threaten rollout programmes