Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries


Nadja van Ginneken1,2,*, Prathap Tharyan3, Simon Lewin4,5, Girish N Rao6, SM Meera2, Jessica Pian7, Sudha Chandrashekar7,8, Vikram Patel1,2


1. London School of Hygiene & Tropical Medicine, Centre for Global Mental Health, London, UK
2. Sangath, Goa, India
3. Christian Medical College, South Asian Cochrane Network & Centre, Prof. BV Moses & ICMR Advanced Centre for Research & Training in Evidence Informed Health Care, Vellore, Tamil Nadu, India
4. Norwegian Knowledge Centre for the Health Services, Global Health Unit, Oslo, Norway
5. Medical Research Council of South Africa, Health Systems Research Unit, Tygerberg, South Africa
6. National Institute of Mental Health and Neuro Sciences, Department of Epidemiology, Bangalore, Karnataka, India
7. London School of Hygiene & Tropical Medicine, London, UK
8. St. Johns Research Institute, Bangalore, India

van Ginneken N, Tharyan P, Lewin S, Rao GN, Meera SM, Pian J, Chandrashekar S, Patel V. Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD009149. DOI: 10.1002/14651858.CD009149.pub2.

To read the full review please follow this linkDOI: 10.1002/14651858.CD009149.pub2/full

In developing countries, most people with mental, neurological and substance-abuse (MNS) disorders do not receive adequate care mainly because of a lack of mental health professionals. Non-specialist health workers, but also other professionals with health roles, such as teachers, may therefore have an important role to play in delivering MNS health care.

Researchers in The Cochrane Collaboration carried out a review of the effects of using non-specialist health workers or other professionals with health roles to help people with MNS disorders in developing countries. After searching for all relevant studies in scientific databases, they found 38 studies published before October 2012. Their findings are summarised below.

What is a non-specialist health worker?

Any type of health worker (like a doctor, nurse or lay health worker) who is not a specialist in mental health or neurology but who may have had some training in these fields. We also looked at teachers, as they can be particularly important in the care of children and youths.

What the research says

The studies in this review were from 22 developing countries. In most studies, lay health workers delivered the mental health care, and addressed depression or anxiety (or both), or post-traumatic stress disorder. The review shows that the use of non-specialist health workers, compared with usual healthcare services:

· may increase the number of adults who recover from depression or anxiety (or both) two to six months after treatment;

· may slightly reduce symptoms formothers with depression;

· may slightly reduce the symptoms of adults with post-traumatic stress disorder (non-specialists and teachers were used in one study);

· probably slightly improves the symptoms of people with dementia;

· probably improves/slightly improves the mental well-being, burden and distress of carers of people with dementia;

· may decrease the quantity of alcohol consumed by problem drinkers.

It is uncertain whether lay health workers or teachers reducepost-traumatic stress disorder symptoms among children. There were too few studies to draw any conclusions about the cost-effectiveness of using non-specialist health workers or teachers, or about their impact on people with other MNS conditions such as epilepsy, schizophrenia, and alcohol and drug abuse problems. In addition, very few studies measured unintended consequences of non-specialist health worker-led care - such effects could impact on the appropriateness and quality of care.

Quality of the evidence

Overall, non-specialist health workers and teachers have some promising benefits in improving people's outcomes for general and perinatal depression, post-traumatic stress disorder and alcohol-use disorders, and patient and carer outcomes for dementia. However, this evidence is of low or very low quality in some areas, and for some issues no evidence is available. Therefore, we cannot make conclusions about which specific interventions using non-specialist health workers to help people with MNS disorders are more effective.