Digital technologies help nonspecialist to offer mental health care in low-resource settings

Text messaging, mobile apps, and other digital technologies are being used in innovative ways to support nonspecialist health workers in increasing access to mental health care in low- and middle-income countries (LIMCs), according to a narrative review in the March/April issue of Harvard Review of Psychiatry. The journal is published in the Lippincott portfolio by Wolters Kluwer.

"There is immense potential to leverage the increasing availability and reach of digital technologies to enhance the capacity, skills, and support for nonspecialist health workers in low-resource settings, all in an effort to alleviate the global burden of mental disorders," write John A. Naslund, PhD, of Harvard Medical School and coauthors. They summarize promising programs that use digital platforms to support delivery of mental health care in resource-poor areas around the world.

Digital Tech Supports Efforts to 'Extend the Reach of the Mental Health Workforce'

A shortage of trained professionals poses major obstacles to delivering adequate mental health care worldwide, and especially in low- and middle-income countries. "Task sharing" - involving community health workers and other nonspecialists in delivering evidence-based psychosocial treatments - has emerged as a promising approach for addressing the global treatment gap.

Access to digital technology is expanding rapidly in most countries, opening new avenues to building the capacity of the mental health workforce through task sharing. Dr. Naslund and colleagues identify seven examples of programs using digital platforms to support nonspecialists in delivering mental health interventions:

• In rural India, community volunteers are using smartphones and mobile apps to access training and information to identify and improve care for individuals with mental health disorders.
• Nonspecialist health workers (all women) in Pakistan are using a tablet-based program to deliver a proven-effective, culturally appropriate psychosocial treatment for postnatal depression.
• In Zimbabwe, nonspecialist health workers are delivering a program targeting depression and other common disorders, reinforcing program content with text messages and cell phone calls.
• A mobile decision-support system is helping community and primary care health workers in rural India to provide screening, diagnosis, and management of mental disorders.
• In low-income areas of Lima, Peru, primary care providers are using a digital platform and mobile app to improve detection and referral for mental disorders, including depression, anxiety, and problematic alcohol use.
• A community-based program in rural China is using a digital platform to increase prescribed medication use and prevent relapse among people with schizophrenia.
• In Nigeria, mobile technology is supporting a stepped-care intervention for postnatal depression, delivered by community midwives.

Representing a wide range of settings, targeted disorders, and research designs, the projects illustrate some of the possibilities of using digital platforms to support task-sharing interventions in LIMCs. While some programs use more-sophisticated digital platforms, others use readily available technologies such as text messages, voice calls, and smartphones. "Importantly, digital technology was largely used to support or strengthen the delivery of existing evidence-based programs for mental health care," Dr. Naslund and colleagues write.

While the seven projects provide highly promising examples, the researchers note that many challenges remain in exploring opportunities for digital technology to drive innovative models of mental health care delivery in lower-resource settings. The researchers add, "We observed that technology did not act as a replacement for human capacity but rather served as an important tool for supporting nonspecialist health workers in their roles."